Burns, a general overview

By Cristiano Antonino Last updated Jun 19, 2023

Let’s talk about burns: a burn is a more or less extensive injury to the skin, which can affect only the superficial layer called the epidermis or also the deeper layers of the dermis

It is a typical injury caused by contact with high-temperature heat sources.

We are not only talking about objects, but also about liquids and vapours.

Burns can be caused by the action on the body of particular chemical agents such as acids and caustic soda

Contact with heat generates an injury because the proteins that make up tissues begin to denature and lose their physiological properties, flaking off.

Edema and erythema develop in the affected area.

In the most severe cases, the alterations can lead to a significant depletion of liquids which, leaving the vascular compartment, induce an alteration in the perfusion of organs and tissues.

Data in hand, burns are now the fourth global cause of domestic accidents and also dominate the ranking of occupational accidents.

While men are more affected in developed countries, in all likelihood due to the greater risks they assume in their work tasks, in developing countries it is women who dominate the ranking, due to their predominantly domestic life.

Burns from flames predominate.

What are the degrees of burns and their symptoms?

Understanding whether the burn is mild or severe is not so complex.

Burns can be divided into three different stages of severity, based on the skin layer affected.

First degree burns affect the most superficial skin layer (called epidermis)

They are the mildest, accompanied by pain and erythema.

They usually heal in a few days, with the burnt skin gradually peeling off, leaving room for new cells.

Sunburn and typical burns from domestic accidents belong to this category.

Second-degree (or partial thickness) burns are those where the deeper layer of skin (called the dermis) is affected by the burn

Second-degree burns can in turn be divided into two categories: simple burns heal spontaneously like first-degree burns; deep burns, similar to third-degree burns, often leave scars.

The skin is reddened and has small clear blisters containing serum and plasma called flittens.

There is more intense burning and sometimes pain that can be relieved with analgesics.

Third-degree (or full-thickness) burns are the most severe

They affect the deeper layers of the skin, reaching as far as muscle, fat or bone tissue.

If caused by flames or hot objects, there is necrosis of the skin with the formation of the typical dry, black scabs.

If, on the other hand, they are caused by an encounter with chemical agents, the burnt skin appears white and mushy.

In this particular type of burn, no pain is felt because the nerve endings are also destroyed.

The remedy is surgery.

How to estimate the severity of a burn?

Estimating the severity of a burn, albeit without the precision of a specialist, is possible by observing certain parameters and present symptoms.

The severity of a burn is usually calculated by relating the total surface area affected, the anatomical area affected, the age of the burn victim (they are necessarily more severe in the elderly and children), and whether there were already lesions on the affected area that could favour the development of infection.

In general, it has been noted that anatomical areas with a thicker skin layer and covered with hair are less sensitive than glabrous or thin-skinned areas, such as armpits and joint folds.

Following this reasoning, minor burns are first degree burns and second degree burns that affect less than 10% of the body surface.

Conversely, burns are considered moderate or severe if they are located on the face, hands, feet, genital area, joints, respiratory tract and digestive tract, or affect more than 10% of the body surface.

All third degree burns are considered severe.

In any case, it should be noted that the situation may be further aggravated if the patient already suffers from certain diseases such as heart disease, diabetes, liver and kidney disease.

Types of burns according to the underlying cause

A further classification of burns is according to the underlying cause.

A heat burn is one caused by an encounter with flames, hot liquids, gases or objects at high temperatures.

A chemical burn occurs when the skin is injured by an encounter with acidic or basic, highly irritating substances.

In this case, burns occur that are so severe that they deeply corrode the skin.

Electrical burns or electrocution are typical of the entry and exit of current from the body.

Current has an entry and exit point and, as it passes through the body, it generates heat.

Especially if the electrical voltage is very high, tissue necrosis can be very deep and extensive and the damage irreparable.

Finally, burns can be caused by radiation.

By radiation is meant both long-term exposure to UV radiation (sunlight and artificial lamps) and X-rays.

Burns: what consequences do they have on the individual?

Burning the skin means damaging not only the body’s largest organ, but also its main protective system against microorganisms outside.

The skin is, in fact, an important filter for the body, and injuring it leads to a loss of the body’s defensive capabilities.

When the skin is affected by a burn, even a mild burn, fluid loss is generated, leading to a more or less severe level of dehydration.

Dehydration affects blood volumes, which are significantly reduced.

Organic perfusion is impaired and the tissues struggle to perform their functions.

Therefore, as a direct consequence of a medium to severe burn, complications such as hypotension and hypovolaemic shock may emerge.

In severe patients, the burn also affects the metabolism, which is greatly increased, leading to significant weight loss in a short time.

If large areas are affected by severe burns, thermal shock may also occur because the skin’s normal ability to thermoregulate is impaired.

Among the visible consequences of a severe burn is the formation of eschar, i.e. a conspicuous area of necrosis and oedema of the tissue.

Paying attention to burns, including mild burns, is essential, because their frequent repetition can increase the risk of developing even malignant neoformations, such as skin melanoma.

Burns, how to diagnose

All burns are harmful and none should be underestimated, even the mildest.

When one is burned, it is always good to see a doctor promptly if the symptoms are severe and if they persist for a long time.

This is to avoid the risk of developing obvious scars, but also complications and all kinds of repercussions on the body’s health.

It is essential to always keep the wound clean to avoid infection.

Diagnosis of a burn is fairly simple and involves direct observation of the injured area.

During the objective test, the doctor assesses the depth and extent; he or she investigates the cause and tries to find out if the person has any other relevant clinical conditions.

Blood and urine tests may be required to see if the burn has led to decompensation or if dehydration is present so severe that intravenous fluid supplementation is required.

Severe dehydration can easily lead the body into a state of shock.

This is typical because fluids, normally contained in the blood, are recalled due to vascular changes in the burned area.

If the burn is caused by open flames, an ECG and chest X-ray may be required to see if there is damage to the lungs and airways as a result of smoke inhalation.

Although in most cases the test is visual, a biopsy may be requested, i.e. taking a part of the damaged tissue to study it and thus provide a more in-depth history.

Remember that if the burn affects the face, hands, feet and genital area, it is considered serious and it is necessary to see a specialist for treatment as soon as possible.

The most effective treatments and prognosis

There are different treatments for burns depending on their severity.

First-degree burns usually heal spontaneously within about a week.

It is essential to keep them constantly clean in order to avoid infection, as burns are still a break in the skin.

In cases where burning or pain is present, the doctor may propose drug therapy with analgesics such as ibuprofen and paracetamol.

Particularly in the first few days, it is recommended to cover the wound with a sterile bandage to further prevent microorganisms from infecting the body.

This type of treatment is also ideal for simple and superficial second-degree burns.

If the pain is more intense, opioids such as morphine can be administered to relieve it.

For these types of burns, the prognosis is generally good.

Once healed, the skin returns to normal.

For deep second-degree burns and all third-degree burns, prompt medical intervention is essential.

For all affected patients, admission to hospital with treatment is necessary, not only to treat the deep wounds, but also to prevent complications to other systems and apparatuses.

The wounds in this case leave conspicuous scars, which can be corrected by resorting to surgical skin graft therapy

Using the biopsy technique, part of the lacerated tissue is taken for study and an area of healthy skin to be re-implanted over the wounds.

In more severe burns, due to the high degree of dehydration and fluid loss, it may be necessary to administer intravenous fluids.

If the part affected by the burn is a joint fold, on which scars form that restrict movement, physiotherapy sessions may be used to perform stretching exercises and facilitate joint mobility.

Obviously, this starts when the graft is successful and the area no longer presents acute problems.

In any case, it is very important to take proper care of the skin until it is completely healed, to avoid infection.

Cleanliness can be ensured by simply running water over the wound, and then covering it with sterile bandages to protect it from pathogens.

It should be remembered that during the healing process it is normal to feel itching, while in electrical burns tingling may be present for a few days.

Fortunately, for severe burns, there are several burn centres, hospital wards with specialised staff and equipment to treat this type of injury.

What to do when you are a burn victim

Here is a small vademecum on what to do if you are a burn victim or someone close to you is a burn victim and needs help.

When the burn is minor and first degree, it is recommended to cool the wound with room temperature water, taking care to clean it properly.

Afterwards, dress it and cover it with sterile gauze.

In the following days, wear cotton clothes and do not crush the area.

Maintain the habit of running cool water over the wound daily (for 15 to 20 minutes) before covering it.

If the burn is severe, remove clothing and accessories.

While doing so, take care not to injure the area further.

If tissue is stuck to the burned skin, it should not be removed.

While waiting for help, have the patient lie down and cover him/her up.

Medical personnel will proceed to recover the victim and take him/her to the nearest burn centre

The person must be covered with a metal sheet, this device keeps the body temperature constant.

Do not apply anything (creams, ointments, lotions) to the burn victim’s skin, do not puncture the blisters and do not give the person anything to drink.

Medical intervention involves checking the patency of the airways and breathing, with possible intubation of the patient.

This is a procedure used when burns result from flames and excessive smoke inhalation may compromise respiratory exchange.

For the severely dehydrated, intravenous fluids are administered to restore normal blood volume.

Blood transfusions are required in rare cases when the haemoglobin level drops excessively.

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