Areas of damage to tissue, usually skin, caused by heat, chemicals, or electricity
- More common in males
- Working with hot or caustic substances is a risk factor
- Age and genetics are not significant factors
In 2007, about 94,000 people in England required hospital treatment for burns, scalds, and fire-related injuries (such as smoke inhalation), and around 200 died as a result of their injuries. Elderly people and young children are particularly vulnerable to the effects of burns.
Most burns are minor and are caused by accidents in the home, such as scalding with hot water. Although almost all minor burns heal quickly, more severe burns often require hospital treatment and can be life-threatening. The degree of severity depends on how deep the burn extends into tissue and the size of the area affected. Burns to sensitive areas, such as the face, hands, feet, or genitals, can be particularly serious.
Burns are usually due to heat, such as fire, hot fluids, or sunlight. However, caustic chemicals, such as certain paint strippers, and electricity (see Electrical injuries) can also cause burns. These burns tend to be more common in men because they are more likely to work in chemical or electrical industries. Burns usually involve the skin, but caustic substances can produce burns in the oesophagus and stomach if they are swallowed. Hot smoke can burn the windpipe and airways.
What are the types?
The skin is made up of two layers: the surface layer, called the epidermis, and the more sensitive dermis underneath. Burns are categorized as first-degree, second-degree, or third-degree, according to the depth of tissue damage.
Burns that affect only the epidermis are known as first-degree burns and are the least severe type of burn. The burned area may be red, slightly swollen, and sensitive to the touch, but blisters do not form. Within a few days, the skin heals and the damaged layer of skin may peel off. Sunburn is one of the most common causes of first-degree burns.
Once the epidermis has been destroyed, the more sensitive lower dermis layer is vulnerable to damage. Damage to both of these two layers is known as a second-degree burn and is usually very painful. The skin becomes red and covered with large blisters filled with clear fluid. After about 3 days, the pain usually decreases, and most second-degree burns should be fully healed within 14 days.
The most serious and deepest type of burn is known as a third-degree burn. In this type, the epidermis, dermis, and the underlying fat are destroyed. Sometimes, this damage may extend into the muscle tissue. The area becomes numb, thickened, and discoloured. Healing is very slow since the damaged dermis cannot regenerate itself, and new skin can grow only from the edges of the damaged area.
Are there complications?
In large second-degree and third-degree burns, fluid is lost from the damaged areas, which may lead to shock and damage to the kidneys (see Kidney failure). Breathing difficulties may arise if the lungs have been damaged by smoke (see Asphyxiation).
Burns are particularly susceptible to infection because the damaged skin can no longer act as a barrier against infection. Infection with bacteria is most common after third-degree burns and may delay healing. If bacteria enter the bloodstream, they may multiply and cause septicaemia.
What can I do?
Seek medical assistance for all but minor burns. Large second-degree and all third-degree burns require specialized hospital care, ideally in a burns unit. Seek medical advice if you have any doubt about the severity of a burn. Anyone with burns on the face or lips must be admitted to hospital immediately in case swelling of the tissues causes the airways to close up and obstructs breathing. Hospital admission is also necessary if someone has inhaled smoke.
Immediately after a minor burn or scald, cool the damaged skin by flooding it with cold water; continue flooding the burned area for at least 10 minutes or until pain is relieved. Do not apply lotions or creams because these may make the burn worse. Remove any constricting clothing, watches, or jewellery around the area then cover the burn with clingfilm. Alternatively, use a sterile, non-adherent dressing and bandage it loosely in place. Check the wound daily for signs of infection, such as swelling, pain, or pus. If infection does develop, consult your doctor.
What might the doctor do?
Minor burns are cleaned and dressed. Dressings are usually changed several times a day. An antibacterial cream (see Preparations for skin infections and infestations) may be applied to help to prevent infection. If an infection does develop, it is usually treated with intravenous antibiotics.
If the burns are extensive, intravenous fluids, painkillers, and oxygen may be given. Mechanical ventilation (see Intensive therapy unit) may be needed if breathing problems develop due to smoke inhalation.
Anyone with severe burns will be monitored to make sure that his or her fluid levels are maintained and that kidney function is not affected. Skin grafting will be considered to aid healing for most severe second-degree burns and for all third-degree burns.
Scar tissue, which is fragile and sensitive, often develops following severe second-degree and third-degree burns. Scarred areas should be protected from the sun with clothing or sunscreen (see Sunscreens and sunblocks). Scars may cause itching, which can be relieved with antipruritic drugs. Scarred areas may also become taut and inflexible, restricting movement if skin over a joint is affected, and skin grafting may be required. Physiotherapy sometimes helps to improve movement.
What is the prognosis?
With correct treatment, minor burns usually heal within a few days; more severe burns may take several weeks. Third-degree burns may take months to heal even if skin grafts are used, and some scarring may be permanent.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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