Burns: Clinical

The skin is the largest organ of the body, and is made of the epidermis, the dermis, and the hypodermis.

Burns result from exposure of skin cells to an overwhelming amount of energy in the form of heat, causing cellular necrosis.

The degree of injury depends on the temperature, the duration of exposure, and the baseline structural integrity of the skin; which means younger children and elderly individuals are at higher risk of injury, because their skin is relatively weaker.

Okay, burns can be classified based on the cause, or by the depth of injury which corresponds to the severity of the burn.

Burns are most commonly thermal, which can result from scalds, such as hot water, or flames, such as from house-fires.

Less commonly, burns can be electrical, like from exposure to lightning strike or high-voltage electrical current, or from exposure to chemical substances, which can be acidic or alkaline.

Based on depth, burns can be first, second, or third degree.

First degree burns are also called superficial burns, and involve the epidermis only.

A prime example would be a simple sunburn from a day on the beach, which appears red, with no blisters.

Second degree burns are further subclassified into superficial partial thickness burns, which involve the epidermis and the superficial dermis, and deep partial-thickness burns, which involve the epidermis and the deep dermis.

Superficial partial thickness burns appear red and are often blistered, whereas deep partial thickness burns appear red or white, with no blisters.

Third degree burns are full-thickness burns, extending through and destroying the entire dermis.

These appear leather-like with a charred appearance and tense feel.

Usually, third degree burns are surrounded by a rim of second degree burns.

Fourth degree burns extend beyond the dermis, destroying fascia, muscle or bone.

Because third and fourth degree burns destroy the entire skin, they destroy the skin nerve endings, and therefore can feel relatively painless.

Due to their strength and velocity, electrical burns have an entrance and an exit wound, similar to a gunshot. But aside from that, the skin actually looks fine.

However internally, the muscles are injured and even heart can be severely damaged, so don’t let normal skin fool you.

Sadly, in children, specific burn patterns raise suspicion for physical abuse. These include burns with a sharply demarcated edge, small circular burns matching a cigarette tip, or burns in the perineal region matching a pattern that could only be explained if the child was dipped into scalding water.