Burns

What are burns?

The damage to body tissues on exposure to too much heat (dry or moist), cold (frostbite), radiation, electricity, friction, or chemicals is called a burn. Burns caused by hot water or steam, are called scalds. Burns are classified into first, second, and third degree, depending on the depth of tissue damage. A first-degree burn makes the skin red, like sunburn, while a second-degree burn causes blistering. A third-degree burn destroys the area of affected skin completely, resulting in serious scarring. Third-degree burns need special care. The treatment of burns depends on their depth and the extent and location of the area affected.

How do they occur?

First-degree burns heal quickly as they affect only the outer layer of the skin e.g. mild sunburn and brief contact with a heat source like a hot iron.

Second-degree burns affect the lower layers of the skins as well, resulting in blisters (e.g. severe sunburn and burns caused by hot liquids). They usually heal without scarring unless they involve a large area.

Third-degree burns can be very serious as they destroy all the layers of the skin as well as any underlying tissue. Third-degree burns usually result from electric shocks, burning clothes, severe fires, etc. Sometimes, burns from electricity can cause damage to deeper tissues, including the heart, with very little superficial skin damage.

What are the symptoms?

A first-degree burn is painful and sensitive to the touch. The skin becomes dry, red, sore, mildly swollen and may peel. It should feel better in a couple of days and heal in about a week if there are no complications.

Second-degree burns are painful and swollen and show redness and blisters. The skin also develops a weepy, watery surface.

The skin in third-degree burns appears discoloured, charred and leathery white with a dry surface. The pain is less than with first or second-degree burns or sometimes none at all, because the sensitive nerve endings in the skin are also destroyed. But pain is felt around the margins of the affected area. There is a rapid pulse and shock depending on the extent of burns. These always require emergency treatment and may require hospitalisation and skin grafting. Patients who sustain burns in closed spaces may develop respiratory distress due to inhalation of toxic and hot gases. They require immediate hospitalisation.

What is the treatment?

Minor burns should be immediately immersed in cold, running water and then covered with a clean, wet towel until the pain decreases. A clean, dry dressing is applied with a loose bandage over the area. Aspirin, paracetamol or ibuprofen are given for pain.

Extensive and deep burns that are chemical or electrical in nature, or those that involve the face, hands feet, genitals or the respiratory tract, are more serious. The patient should be taken to the hospital for treatment, or transferred to a burns centre. As a first aid measure, he should be made to lie down and wrapped in a warm blanket to minimize shock.

Treatment may include covering the burned area with a dressing. Antibiotics and intravenous fluids are given to prevent infection and treat fluid loss. Skin grafting may be done which involves transfer of normal skin (from the inside of the thigh or the forearm) to the burn site.

How to take care of superficial burns (first or second degree)?