Understanding Burn Injuries

Burn injuries are classified according to the extent and depth of the injury. Understanding the extent of the burn is essential to determining the need for treatment, including hospitalization.

The depth of the burn injury is classified as First-, Second-, or Third-degree, and Partial or Full Thickness. First- and Second-degree burns are usually partial thickness in depth and will heal spontaneously. Third-degree or full thickness injuries usually require skin grafting.

First-degree Burns
First-degree burns are limited to the epidermis, or upper layers of skin. They are moist, red in color, and very painful. There are usually no blisters, and they often heal within seven days. The most common type of first-degree burn is a sunburn.

Second-degree/Partial Thickness Burns
These burns penetrate more deeply into the skin and destroy all layers of the epidermis and several layers of the dermis. These burns are usually categorized as superficial or deep.

Superficial burns involve only the outermost layer of the dermis, and are defined by extreme pain and hypersensitivity to touch. The skin will be moist and have a mottled pink or red appearance to it. It will blanch on pressure, and there are usually blisters present. Superficial burns usually heal automatically.

Deep burns destroy tissue into the deeper layers of the dermis. Those burns are usually dry and whitish in appearance. The skin does not blanch, and extreme pain will occur. Healing may take up to three or four weeks, possibly leaving hypertrophic, or thick scars.

Third-degree/Full Thickness Burns
These burns involve destruction of the epidermal and dermal layers, as well as extending into the subcutaneous tissue. The skin is charred and leathery, often depressed from the surrounding tissue. These burns are usually not painful due to the fact that all nerve endings have been destroyed. Third-degree/Full thickness burns require skin grafting in order to heal.

Types of Burns
Thermal- An injury caused by exposure to heat, sufficient enough to cause damage to the skin, and possibly deeper tissue. They are caused by: Flame- These burns are often deep, especially when they are caused by ignited clothing.
Hot Liquids- Though not as deep as those burns produced by flame, scalds can also produce deep burns. Hot water or coffee, usually produce deep partial thickness injuries, while grease or hot soup may produce deep partial to full thickness injuries.
Hot Objects- These are usually contact burns caused by touching a hot object such as a stove burner. They vary in depth due to the differences in personal reflexes from person to person. Prolonged contact can lead to full thickness injuries.
Flash Injuries- Often involving the face and hands, flash injuries occur when automobiles, gas tanks, and airplanes explode. These injuries also vary in depth according to the proximity of the flash and the intensity.
Sunburn- Usually superficial, sunburns can be extremely painful. By cooling early, the wound is soothed and progress is stopped, so pain is relieved also.

Chemical- These are usually a reaction that occurs when the skin comes in contact with strong acids, alkalis, and other corrosive materials. They are the result of the conversion of chemical energy into thermal energy. The burn usually progresses as long as the chemical remains in contact with the skin. Electrical- These usually occur when an electric current travels from the contact site into the body, arcing from one body point to the other. As the current goes through the body it is converted into heat, which causes extensive damage along the current flow. These burns include: Contact Burn Injuries- The current is most intense at the point of entry, exit, and along the tissue it damages. It may present a "bull's-eye lesion" where there is a charred zone in the center, a middle zone of gray dry tissue, and an outer red zone. The most serious damage could be undetectable, as it is along the path of the current. Electrical currents may also cause damage to the lens of the eye and the heart. Flash Burn (Electrical)- This is an electro-thermal injury caused by the arcing of the current. Flame Burn- This occurs when electricity ignites a person's clothing or surrounding material. Mechanical- These burns are caused by friction, usually from ropes, carpet, or in sports activities.

Burn Care
Burns should be evaluated by a physician, except in the case of mild sunburn, where home treatment is safe and effective.

The first step in treating a burn is to stop its progression. If clothing is saturated with caustic chemicals or hot substances, it should be removed at once. The affected skin area should be placed in cold water, but not ice as it can cause frostbite and further damage burned skin. If cooled within the first few minutes, cold-water emersion for up to 30 minutes can reduce both the total area involved and the depth of the burn.

In the case of minor first- and second-degree burns, once the burn has been cooled, a lotion or moisturizer can be applied to prevent cracking, peeling, and general drying out of the skin. Over the counter pain relievers can also be used. Do not apply butter to soothe a burn. It will hold the heat in the wound, causing greater damage and possible infection.

A light gauze dressing and petroleum jelly can be used to cover the burn. Applying a bandage will keep air away from the area and reduce pain. If there are blisters present, do not break them. Blisters protect healing skin from further damage and infection. If the blistering area is larger than the palm of your hand, consult a physician immediately.

Dressings should be changed once or twice daily, and the area washed gently with an anti-bacterial soap. This process may need to be continued for up to three weeks. In addition, if you notice any signs of infection, immediately contact a physician.