Case Study: Partial-Thickness Burns — Acute Phase and Reconstructive Medications

James Wong — Founder & Pharmacist, LienScripts | January 10, 2025 | 6 min read

A 29-year-old woman suffered partial-thickness burns on both arms and hands from a defective space heater. With no health insurance and a product liability claim pending, a pharmacy lien covered everything from acute pain management through scar treatment and psychological support.

Case Study: Partial-Thickness Burns — Acute Phase and Reconstructive Medications

Details have been modified to protect patient privacy. This is a composite account based on real scenarios encountered in our practice.

Burn injuries occupy a category of their own in personal injury medicine. The acute phase is intense — pain that is frequently described as among the worst a human being can experience. But the aftermath of a significant burn injury extends far beyond the acute phase, into months of wound care, scar management, and often profound psychological consequences. Each phase has its own medication requirements. Together, they create a treatment arc that a pharmacy record can document with unusual completeness.

[!KEY] Sofia, 29, suffered partial-thickness burns over 18% of her body from a defective space heater, requiring medication phases spanning acute pain control, wound care, scar management, and PTSD treatment — the pharmacy record's chronological breadth proved the full scope of her damages.

Patient Background

Sofia was 29 years old, working as a freelance graphic designer from her home apartment when the space heater in her bedroom malfunctioned. She woke to the smell of burning fabric. The heater's plastic housing had cracked and made contact with her bedding. By the time she registered what was happening, her arms and hands were in contact with a burning surface.

She sustained partial-thickness burns on both arms and both hands — an estimated 18% total body surface area (TBSA). Partial-thickness burns, also called second-degree burns, involve both the epidermis and a portion of the dermis. They are intensely painful because the nerve endings in the dermis remain intact and are directly exposed. They can heal without surgical intervention when properly managed, but they require weeks of careful wound care and remain vulnerable to infection during the healing period.

Sofia was hospitalized for eight days. She had no health insurance. Her attorney filed a product liability claim against the space heater manufacturer.

Acute Phase: Pain and Wound Management

The acute burn pain in Sofia's case was severe. Both hands and both arms were involved, which meant that the most functionally important parts of her body — the ones she used for her work as a graphic designer — were the most significantly affected.

Her medication regimen during the acute and early post-hospital phase included:

Pain management:

• Hydrocodone/acetaminophen — scheduled dosing for acute pain management, transitioning to as-needed use as the wounds began to close
• Gabapentin — critical for burn neuropathic pain, which is physiologically distinct from nociceptive pain and responds poorly to opioids alone. Burn-related nerve pain arises from direct damage to cutaneous nerve fibers and persists long after the wounds themselves have healed

Wound care:

• Silver sulfadiazine cream — the standard topical antimicrobial agent for partial-thickness burn wounds during the early healing phase, applied to dressings to prevent infection
• Bacitracin ointment — used at wound margins as healing progressed and the risk profile changed

Pruritus (itching) management:

• Doxepin cream (topical) — burn pruritus is a severely undertreated symptom. As healing begins, the damaged skin generates intense itching that can be more functionally disabling than the pain itself. Doxepin cream provided topical relief without systemic sedation
• Hydroxyzine (oral) — for breakthrough pruritus and anxiety management, particularly at night when itching tends to worsen

Reconstruction Phase: Scar Management

As Sofia's wounds moved from the acute healing phase to the remodeling phase, the medication profile shifted.

Silver sulfadiazine was discontinued once the wound bed had developed a healthy granulation layer. It was replaced with:

• Silicone gel sheeting applied to the healing burn sites — silicone is the most evidence-supported topical modality for hypertrophic scar prevention following burns. Applied consistently over weeks to months, it reduces the risk of raised, thickened scarring that would otherwise be both cosmetically significant and functionally limiting on the hands and arms

The transition from wound treatment to scar treatment is a phase that often goes undocumented in cases where the patient manages their own care without a consistent pharmacy. In Sofia's case, the pharmacy record captured the discontinuation of silver sulfadiazine and the addition of silicone gel — documenting the natural progression from acute wound care to reconstructive care.

[!KEY] The transition from silver sulfadiazine to silicone gel in a burn pharmacy record is itself clinical evidence — it documents the wound's progression from active infection risk to scar remodeling phase, giving the demand package a timeline of healing that adjuster arguments about early resolution cannot credibly contest.

Psychological Medications

Sofia developed post-traumatic stress disorder and depression in the months following the burn injury. This was not unexpected. Burns are among the most common precipitants of PTSD in adult civilians, and the combination of severe acute pain, prolonged wound care requirements, visible scarring, and the disruption of her ability to work created a significant psychological burden.

Her treating psychiatrist prescribed:

• Sertraline — first-line pharmacological treatment for PTSD and major depressive disorder. The prescription was specifically documented as related to the burn injury and its psychological sequelae
• Trazodone (low dose, as needed) — for sleep disruption, a prominent symptom in both PTSD and burn recovery

These medications were included in the pharmacy lien from the time they were prescribed. The documentation of psychological medications — when clearly tied to a traumatic injury event and prescribed by a treating psychiatrist — supports the damages argument for psychological injury in ways that self-reported symptom descriptions alone cannot.

[!KEY] Psychiatric medications — sertraline for PTSD, trazodone for sleep disruption — are strongest as damages support when the pharmacy record's start dates correlate with documented clinical notes from the treating psychiatrist linking the prescriptions to the injury event; attorneys should confirm that causation language appears in the psychiatrist's chart before using the pharmacy record at mediation.

The Insurance Gap and the Pharmacy Lien

Sofia had no health insurance at the time of the injury. Her freelance income had made marketplace coverage feel unaffordable, and she had let her policy lapse earlier in the year.

The hospitalization was covered through a provider agreement with a lien-based hospital. But the extensive outpatient medication regimen — spanning months, evolving from acute pain medications through wound care agents, scar management, and psychiatric medications — had no coverage mechanism until her attorney enrolled her in a LienScripts pharmacy lien.

The enrollment was completed on the day of hospital discharge. From that point forward, every outpatient prescription tied to the burn injury was covered at zero upfront cost to Sofia. As her medication needs evolved — as gabapentin was continued for persistent neuropathic pain, as psychiatric medications were added — those medications were added to the lien with no approval delays.

Documentation That Supported the Damages Picture

Product liability cases require a comprehensive damages picture. Sofia's injuries were not a single event with a clean recovery arc — they were a prolonged, multi-phase experience that touched nearly every domain of her life: physical pain, functional impairment of her hands and arms, the sustained wound care burden, the cosmetic impact of scarring, and a serious psychological injury.

The pharmacy record documented each phase with clinical specificity:

• Acute pain medications documenting the intensity of the initial injury
• Gabapentin continuing beyond the acute phase, documenting persistent neuropathic pain
• The wound care progression from silver sulfadiazine to silicone gel, documenting the healing timeline
• Pruritus medications documenting a frequently overlooked aspect of burn recovery
• Psychiatric medications documenting the psychological sequelae — with dates that placed the onset of PTSD in the months following the injury

No single document created the damages picture on its own. But the pharmacy record, spanning from the day of discharge through the months of active litigation, was a chronological thread that connected every phase of Sofia's experience.

Outcome

The case resolved for a figure that fully compensated Sofia for her injuries, disfigurement, and psychological damages. The product liability claim against the manufacturer was supported by evidence that extended beyond the initial burn event to the full scope of what the defective heater had taken from her — including the months of medical treatment her pharmacy record documented in detail.

Key Takeaways for Attorneys

1. Burn injuries have phases — and each phase should be documented. The pharmacy record in a burn case is not just an acute injury document. It should reflect the wound care progression, the scar management phase, and the psychological medication phase. Enrolling the client on the day of hospital discharge ensures every phase is captured from the start.

[!TIP] Enroll your burn injury client in a pharmacy lien on the day of hospital discharge — the pharmacy record should capture every phase from acute pain through scar management and psychiatric medications to fully document the scope of damages.

2. Gabapentin for burn neuropathic pain is not the same as gabapentin for back pain. When presenting a burn case, make the clinical distinction explicit: neuropathic burn pain arises from direct damage to cutaneous nerve fibers and often persists for months after wound healing. Continued gabapentin use after the wounds close is clinically appropriate — and the pharmacy record documents that continuation.

3. Psychiatric medications need clear causation documentation. Sertraline for PTSD is a stronger damages support when the prescription explicitly references the precipitating event in the treating psychiatrist's notes. Work with the treating provider to ensure that documentation exists before settlement.

"No single document created the damages picture on its own. But the pharmacy record, spanning from the day of discharge through the months of active litigation, was a chronological thread that connected every phase of Sofia's experience."

Key Takeaways for Patients

1. Burn pruritus is a real medical symptom — not just discomfort. Itching following burns can be as disabling as the pain itself. Seek treatment for it and make sure it is prescribed and filled through your pharmacy lien record. It is part of your injury's documented impact.

2. Scar management medications are part of your damages. Silicone gel and other scar management agents prescribed by your treating team are components of your burn injury care — not cosmetic afterthoughts. They belong in your pharmacy record and in your damages argument.

3. Psychological effects of a burn injury are legitimate injuries. PTSD and depression following a severe burn are well-recognized medical consequences. Treatment for these conditions — when prescribed by a qualified treating provider and tied to the injury — is compensable.

Related Resources

• Burn Injury Medication Management and Pharmacy Liens
• Sertraline After a Traumatic Accident
• Gabapentin for Nerve Pain After Injury
• Hydroxyzine for Anxiety and Sleep After Injury
• For Attorneys: How LienScripts Works
• Pharmacy Services for Personal Injury Clients: How It Works