BURNS

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Last Updated : 2/15/2011
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Ira Shah
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BURNS
Burns are death and necrosis of a tissue due to heat. Burns may occur due to dry heat, (in form of fire) wet heat (in form of scalds) or

electrical burns

.

Pathophysiology
Heat damages the cells of the skin releasing chemicals that stimulate nerves and cause pain. Burn heals when a new layer of skin grows in from the edges of the burn. However, if the burn is very large or very deep, bacteria may invade and cause infection. Also due to evaporation of fluids from the open wound, the patients may get dehydrated. Hence the 2 major short term complications of burns are infection and dehydration. Long-term, during healing, the wound may start shrinking or becoming smaller leading to contractures. Contracted tissue may lead to a loss of normal motion if present in the limbs and can also cause a distorted appearance due to pull on the surrounding healthy tissue. In a burn patient, sensations of hot, cold, wetness, dryness, touch and pain may change even permanently . A patient post-burn will not to be able to sweat properly due to damaged sweat glands. Hence appropriate clothing as per the season is required (cotton in summer and warm clothing in winter)

Skin color is determined from the melanin and carotene pigments in the epidermis. Melanin protects the skin from sunburn. After a burn, the burnt skin may not be able to produce melanin, hence leading to sun burn. Also the skin may become lighter(depigmented or hypopigmented ) as compared to the normal skin or darker (hyperpigmented).

Types of Burns

Burns are divided into 3 different types:

First degree or superficial burns

:

It is commonly seen with a sunburn. It is usually red and blanches (becomes white) on pressure. It occurs due to damage to only the top (epidermis) layer of the skin. It heals by itself in 3-6 days and generally dose not require hospitalization.

Partial thickness burns or second degree burn
:
It involves the entire epidermis and some portion of the dermis. They are of 2 types:
- Superficial partial thickness burn: They are painful and associated with blisters. They heal within 3 weeks without any visible scars. There may be some pigment changes.
- Deep partial thickness burns: They are dry white in color. They may cause scarring and take longer to heal. Skin grafting is usually required for healing.

Full thickness burns
:

They involve the entire epidermis and dermis. They are dry and leathery in appearance. They cause scarring and require immediate skin grafting and use of compression garments.



Contributor Information and Disclosures Ira Shah
Consultant Pediatrician, B.J.Wadia Hospital for Children, Mumbai, India


First Created : 2/28/2001
References
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