Case Study: Minor Partial-Thickness Burn with Complicating Health Anxiety

Case at a Glance

An 18-year-old male sustained a small, second-degree burn on his thumb from a hot oven. Despite appropriate initial first aid and reassurance from a medical helpline, he presented with significant health anxiety, seeking further validation regarding the severity and management of his injury.

Patient's Story

The patient, an 18-year-old male with no significant past medical history and a self-described slender build, presented for an online consultation 26 hours after a burn injury. The previous evening, while removing a pizza from an oven preheated to over 200°C (392°F), he accidentally touched the dorsal aspect of his thumb to the hot, metallic interior surface. He immediately withdrew his hand and cooled the area under cold running water for approximately 15-20 minutes. He then loosely covered the burn with plastic cling film and contacted a national non-emergency medical helpline. After describing the incident and the appearance of the burn, he was advised that home care was sufficient and a hospital visit was not necessary. Despite this, the patient reported experiencing significant anxiety, stating he has a tendency to 'panic with this type of thing,' which prompted him to seek a second opinion.

Initial Assessment

Upon presentation 26 hours post-injury, the patient described the burn as being smaller than his pinky fingerprint. The area was shiny and red, with a slightly paler, whitish area in the center. A small, raised line of what appeared to be devitalized tissue was noted. Crucially, no blistering had occurred. The initial pain, which was severe immediately following the injury, had subsided completely and was replaced by numbness, even to light touch. The patient's primary concern was not the physical discomfort but rather his anxiety about the burn's severity and potential for complications.

The Diagnostic Journey

The diagnostic process was based on the patient's detailed history and a provided photograph of the lesion. The mechanism of injury (brief contact with a very high-temperature surface) and the physical signs were key indicators. The combination of redness, a pale center, and localized numbness pointed away from a simple superficial (first-degree) burn. The absence of blistering is common in small, deep partial-thickness burns. The assessment by the national helpline was consistent with an injury that could be managed at home, but the patient's subjective experience of anxiety was a significant factor requiring attention.

Final Diagnosis

1. Superficial Partial-Thickness (Second-Degree) Burn of the thumb.
2. Health Anxiety.

Treatment Plan

The treatment plan focused on both wound care and psychological reassurance.

1. Wound Care: The patient was advised to keep the burn clean by washing it gently with mild soap and water daily. He was instructed to keep the area covered with a sterile, non-adherent dressing to prevent infection and promote healing. He was also counseled to monitor for signs of infection, such as increased redness spreading from the site, swelling, purulent discharge, or fever.

2. Anxiety Management: Acknowledging and validating the patient's anxiety was a critical component. Simple, direct reassurance was provided, confirming that the burn appeared minor and the initial advice he received was appropriate. This external validation was crucial for alleviating his immediate distress.

Outcome and Follow-up

After receiving professional reassurance online, the patient reported feeling a 'lot more peace of mind.' Given the small size and nature of the burn, it was expected to heal uneventfully within 1-2 weeks with minimal to no scarring, provided proper wound care was maintained. No formal follow-up was scheduled, with the instruction to seek in-person medical care only if signs of infection developed. The case highlights the importance of addressing psychological distress, such as health anxiety, which can be a significant comorbidity even with minor physical injuries.