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Dermatology => Skin => Burn
Burn
INTRODUCTION
Burn, injury to the skin and deeper tissues caused by hot liquids, flames, radiant heat, direct contact with hot solids, caustic chemicals, electricity, or electromagnetic (nuclear) radiation. Skin exposed to temperatures as low as 120°F is burned after about 5 minutes.
INCIDENCE
Approximately 2 million persons suffer serious burns in the United States each year; of these 115,000 are hospitalized and 12,000 die.
CLASSIFICATION
The severity of a burn depends on its depth, its extent, and the age of the victim. Burns are classified by depth as first, second, and third degree. First-degree burns cause redness and pain (e.g., sunburn). Second-degree burns are marked by blisters (e.g., scald by hot liquid). In third-degree burns, both the epidermis and dermis are destroyed, and underlying tissue may also be damaged. The extent of a burn is expressed as the percent of total skin surface that is injured. Persons under 1 year and over 40 years old have a higher mortality rate than those between 2 and 39 for burns of similar depth and extent. Inhalation of smoke from a fire significantly increases mortality.
PATHOLOGY
Thermal destruction of the skin permits infection, which is the most common cause of death for extensively burned persons. Body fluids and minerals are lost through the wound. The lungs, heart, liver, and kidneys are affected by the infection and fluid loss.
TREATMENT
First aid for most burns is cool water applied soon after the burn. Application of home remedies should be avoided. Burns of 15 percent of the body surface or less are usually treated in hospital emergency rooms by removing dead tissue (debridement), dressing with antibiotic cream (often silver sulfadiazine), and administering oral pain medication. Burns of 15 to 25 percent often require hospitalization to provide intravenous fluids and avoid complications. Burns of more than 25 percent are usually treated in specialized burn centers where aggressive surgical management is directed toward early skin grafting and avoidance of such complications as dehydration, pneumonia, kidney failure, and infection. Pain control with intravenous narcotics is frequently required. The markedly increased metabolic rate of severely burned patients requires high-protein nutritional supplements given by mouth and intravenously. Extensive scarring of deep burns may cause disfigurement and limitation of joint motion. Plastic surgery is often required to reduce the effects of the scars. Psychological problems often result from scarring.
RESEARCH
Investigations are under way to improve burn victims' nutritional support, enhance the immune response to infection, and grow skin in tissue culture to cover large wounds from small donor sites.
PREVENTION
Since over 50 percent of all burns are preventable, safety programs can significantly reduce the incidence of burn injuries.
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