Burns

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Burns are categorized as a type of damage to the skin and its underlying tissues. Most skin burns are minor injuries that usually occur at work or home. Although kids are more prone to such incidents, adults are no different. Burns are characterized by a burning sensation around the injured area and severe skin damage. Although minor burns caused by spilling of hot water or touching a hot stove can be treated at home, more serious burns require urgent medical attention to prevent complications.

Severe burns can cause severe or life-long complications. One of the most concerning problems is the body’s inflammatory response to burns. A typical response protects the body from offenders like bacteria and virus. Yes, often for severe burns, the body’s immune system may overreact, causing injury to be more powerful and affects various organs like the heart and lungs. Shock is also something that can take place in case of a severe drop in blood pressure. Infections are also a significant concern in burn victims and need critical and timely care to recover. Untreated infections may result in sepsis.

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Types

Depending on the layer of the skin that is affected, the type and severity of skin burns are determined. However, burns are classified into three levels: 1st degree, 2nd degree and 3rd degree burns:

1st degree burns: In this case, the top layer of the skin, known as epidermis, is affected. The main causes of this type of burns are sunburn, scalding from hot water, steam or electric burns and radiation. It is also known as superficial burns, which are painful and tender and normally heal within 10–15 days. Wounds caused because of these burns are dry, red and cause discolouration of the skin in certain cases.

2nd degree burns: Also known as partial thickness, these types of burns damage the second layer of the skin, i.e., dermis. These wounds are white, pink or red in colour and moist in nature. Characterized by skin blisters, they are quite painful and result in skin discoloration of the affected area without scarring.

3rd degree burns: These wounds involve the epidermis and dermis along with nerve endings, blood vessels, hair follicles and sweat glands, they are known as full thickness burns or 3rd degree burns. These wounds cause little or no pain (because of nerve damage) and have a charred appearance. They leave scars and are leathery, dry in nature. If third degree burns affect only a small area, they take a few months to heal; however, for ones affecting large areas, skin grafting is the only option. Burns that affect 10 per cent of a child's body and those that affect 15 per cent–20 per cent of an adult's body are major injuries and require hospitalization and extensive care.

Symptoms

The commonly observed signs and symptoms of burns include –


  • Pain (it is dependent on the type and severity of skin burns)

  • White, pink, red or charred skin

  • Skin peeling

  • Swelling

  • Skin blisters

  • Difficulty in breathing, burned lips and voice changes (are seen in case of inhalation injury)

Causes And Risk Factors

CAUSES

Usually, a burn is caused by the energy transfer of an object to the body. There are different types of burns caused by various conditions listed below:

Thermal burns

These type of burns are caused because of external sources of heat that increase the skin's temperature reaching the tissues and causing tissue damage and cell death. Hot utensils, boiling liquids, steams, and flame can cause thermal burns when exposed to the skin.

Radiation burns

Prolonged radiation to the sun without any layer of protection causes radiation burns; it can also be caused by X-Rays.

Chemical burns

Exposure to strong acids, alkalis, detergents or solvents that come into contact with the skin and eyes cause burns called chemical burns.

Electrical burns

Burns that occur because of electrical current, alternating current (AC) or direct current (DC) via plugs and electrical appliances are known as electrical burns.

RISK FACTORS

People approaching the emergency department with burn cases are widespread. Children are more prone to accidental burns, and almost 300 children receive emergency treatment for burns. Population such as teenagers and older people are at risk because of injuries from cooking or spilling of hot water onto skin. Lighters/matches/fireworks are the reason for burns in children and teens.

Prevention

Accidents are the leading cause of burns. To reduce the risk of burns, take the following precautions:


  • Make use of sunscreen with good SPF.

  • You must check the water heater’s temperature always before entering the bath.

  • You should handle chemicals, lighters and fireworks with care.

  • Check whether the stove is off; never keep it attended.

  • Try to keep children away from hot objects such as pots, pans and, irons.

  • Keep an active fire extinguisher, check for its maintenance and proper working.

  • You must cover the electrical outlets to avoid any electric glitch leading to fires.

  • Use smoke detectors in homes and offices.

Diagnosis

Treatment

The treatment options are determined by the severity and type of burns. A first degree burn and second degree burn (if the affected area is not more than 3 inches long) can be treated with home remedies. However, people suffering from third degree burns should be taken to the nearest hospital at the earliest. Whenever a person suffers from burn injury, hold the burned area and immerse under running tap water for 10 min. Never place ice on the affected area. You can either place salt over it or loosely cover the area with a bandage. In case of pain, have over the counter painkillers to combat pain and wait for the burn to naturally heal.

Apart from homecare measures, people with significantly large areas of third degree burns may have to undergo procedures for skin regeneration such as:

Skin grafting: It is a standard treatment option for burn injuries. In this method, a skin graft (skin from other part of the body) is surgically stitched over the affected area. Although the grafted skin looks like a patchwork, the skin appears to look similar to the original skin over time.

Stem cell treatment: In this process, stem cells are collected from fat tissue or blood sample and separated and cultured in the lab. Using a surgical procedure, the separated stem cells are placed on the affected area and covered with collagen, skin protein. Over time, the stem cells form new skin layer and differentiate into skin cells and tissue.

Lifestyle/managementreferences

You can also try to treat minor burns at home. Common ingredients used to treat burns caused by oil scalding or boiling water are –


  • Honey

  • Diluted vinegar

  • Aloe vera

  • Diluted lavender oil

  • Banana peel and yoghurt


There can be certain changes in diet and lifestyle that will benefit you and help you to quickly recover from burns:

  • You should include protein in every meal and snack. Including protein helps to rebuild the loss of muscle. Protein containing food includes chicken eggs and yoghurt.

  • Carbohydrates help in preventing muscle loss, along with intake of potatoes and beans, and rice has proven to be effective too.

  • Eat small frequent meals.

  • Keep yourself hydrated. Avoid drinks containing a lot of sugar and soda.

  • You should include fibre in your meal.

  • Do not overeat.

  • Talk to your physician about adding necessary vitamins and minerals to your diet.

Prognosis And Complications

Prognosis

More than half of the people suffering burns recover. However, this was not the condition a few years back. People with burns covering 90 per cent of the body can have a good lifestyle with reasonable care. But patients usually suffer from the presence of some impairments and scars.

Complications

The chances of health complications are quite high in case of burns because the integrity of the skin is damaged. Patients of severe burns may experience organ failure, pneumonia and septic shock. Common problems experienced by people with burns include:

Risk of infections: There is an increased susceptibility to various infections and diseases as the burned skin is exposed, leading to pollutant and bacterial attack.

Scarring and contractures of skin: Thin and wrinkly appearing skin is termed atrophic, thick scar is known as hypertrophic and thicker and larger scar are called keloidal.

Pigmentation: It is commonly seen in people with dark burn marks and often decolorizes the normal colour of the skin.

Joint or bone pain: If the burns are deep and reaches the bone or joints, it leads to pain. This is because the scar tissue makes muscles and tendons to shorten, leading to pulling of joints and bones.

References

NIGMS. Burns[Internet] [Updated : July 07 2020] Available at: https://www.nigms.nih.gov/education/fact-sheets/Pages/burns.aspx. Accessed on: March 15 2021. (https://www.nigms.nih.gov/education/fact-sheets/Pages/burns.aspx)

Cleveland Clinic. Burns [Internet] [ Updated : Aug 24 2020] Available at: https://my.clevelandclinic.org/health/diseases/12063-burns. Accessed on: March 15 2021. (https://my.clevelandclinic.org/health/diseases/12063-burns)

Phoenix Society. Eating Healthy after Burn. [Internet] [Updated :Aug 28, 2019] Available at: https://phoenix-society.org/resources/eating-healthy-after-a-burn-injury. Accessed on: March 15 2021. (https://my.clevelandclinic.org/health/diseases/12063-burnsj)

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