Brief overview
- Treatment: Varies depending on the severity or depth of the burn wound
- Causes and risk factors: Exposure to intense heat (e.g. contact with hot liquids, flames, radiation)
- Symptoms: Pain, blistering, skin discoloration, loss of pain sensation, etc.
- Diagnosis: Interview (medical history), physical examination, blood tests, needle test, bronchoscopy
- Disease progression and prognosis: Depends on the depth and extent of the burn, age, previous illnesses and concomitant injuries
- Prevention: Safe handling of electrical appliances and open fires, precautionary measures, education
What are burns and what degrees are there?
A burn is damage to the skin caused by direct exposure to heat. Contact with hot liquids is referred to as scalding. Hot or heated objects cause so-called contact burns.
Accidents involving chemicals result in chemical burns or chemical burns. Burns caused by electric current (electric shock) are referred to as electrical burns. UVA or UVB rays and X-rays cause so-called radiation burns.
In severe cases, this is referred to as burn disease. This occurs in adults with a large-area burn of more than 15 percent and in children with more than ten percent.
Burn disease is typically characterized by the phases of shock, edema reabsorption and inflammation/infection.
Frequency
Every year in Europe, millions of people with burns are treated by general practitioners and thousands are hospitalized. Many of them require intensive medical treatment and are hospitalized with burns and chemical burns. 180,000 people worldwide succumb to burn injuries every year.
Burns in adults are typically caused by flames or hot gases (e.g. deflagrations after an explosion). In children and the elderly, however, scalds occur most frequently. Burns usually occur in the home or at work.
Structure of the skin
The outermost layer is the epidermis. The superficial horny layer with its protective film of sebum and sweat prevents the penetration of bacteria, fungi and foreign substances. The epidermis also protects the body from drying out.
The dermis (corium) lies directly beneath the epidermis. This is where the finely branched blood vessels that supply the skin, muscle cords and nerves run. The upper cells of the dermis are more active than the lower ones. This is why a superficial dermis burn heals more easily than a deeper one.
Underneath is the subcutis, which consists of fatty tissue and is permeated by larger blood vessels and nerves.
Depending on the depth of a burn, burns are classified into four degrees (degrees of burn):
1st degree burn
In a first-degree burn, the burn is limited to the epidermis, usually only to the superficial horny layer (stratum corneum).
2nd degree burn
A 2nd degree burn damages the skin down to the uppermost corium layer. Read everything you need to know about 2nd degree burns here.
3rd degree burn
Third-degree burns can occur on various parts of the body (e.g. face), damage the entire epidermis and extend into the subcutis.
4th degree burn
A 4th degree burn chars all layers of the skin and often also affects the underlying muscle tissue with bones, tendons and joints.
How are burns treated?
Treatment depends on the severity of the burn. For 1st degree and 2nd degree type a burns, treatment is usually conservative, i.e. with medication. The treatment of the burn includes, among other things
- cooling
- Wound cleansing
- Application of special antiseptic preparations
- Applying a bandage
In the case of 2nd degree type b burns and above, further treatment steps may be required, such as surgery to remove dead tissue or skin grafting (transplantation).
Aftercare for burns may also include the use of special plasters for scar care.
What to do for burns? Read everything you need to know about the treatment of burns, how to treat scalds and relieve pain here.
What home remedies help?
Home remedies may help with a burn, but their effectiveness is often not scientifically proven. It is assumed, for example, that compresses with chamomile flowers may have a calming and anti-inflammatory effect and also promote wound healing.
Home remedies have their limits. If the symptoms persist over a longer period of time and do not improve or even get worse, you should always consult a doctor.
Burns: symptoms
In the case of particularly deep burns, some patients no longer have any pain at all, as the nerve endings are just as burnt as the rest of the skin tissue. The severity of a burn or scald depends not only on the temperature, but also on the duration of exposure.
Blisters form after a burn when the epidermis separates from the underlying dermis. The epidermal cells swell and die (vacuolizing degeneration).
An open burn wound oozes because fluid escapes from the bloodstream. In the early phase after a burn, the skin or the dead tissue appears white and later turns into a black-brown scab.
In general, severe burns usually affect the entire organism. The dead tissue may lead to kidney failure via certain mechanisms.
Due to the loss of body fluids and proteins through the burn injury, the tissue is no longer sufficiently supplied with blood and oxygen. Patients complain of dizziness or even lose consciousness.
Depending on the degree of combustion, the following symptoms may occur:
Degree of burn
Symptoms
I
Pain, swelling (edema), redness (erythema), burn like sunburn
II a
Severe pain, blistering, the skin appears pink at the site of the burn (pink wound bed), hair is still firmly attached
II b
Less pain, wound base paler, blistering, hair can be easily removed
III
no pain, skin appears dry, white and leathery, no hair present.
There is irreversible tissue death (necrosis).
IV
Completely black charred body areas, no pain
Scalding
Viscous liquids retain heat better and often cause more damage to the skin than water, for example. Different degrees of burns usually occur simultaneously. So-called rind marks are often visible.
Inhalation trauma
Inhaling hot gases or air mixtures can cause damage to the respiratory tract. This so-called inhalation trauma usually has an unfavorable effect on the general healing process of the patient.
Burns to the head and neck, burnt nasal and eyebrow hair and traces of soot in the throat and nasopharynx indicate such damage. Those affected are usually hoarse, have difficulty breathing and cough up soot.
Electrical burns
As the bones offer great resistance, nearby muscle tissue is usually destroyed. The severity of an electric burn also depends on the type of current, the current flow and the duration of contact. In most cases, there is only a small, inconspicuous skin wound through which an electric current has entered the body.
Causes and risk factors
Burns and scalds occur when the body is exposed to extreme heat. Tissue is destroyed at temperatures above 44 degrees Celsius. With prolonged exposure to heat, temperatures above 40 degrees Celsius are sufficient. In addition to the temperature, the duration of exposure to heat plays a significant role in the development of a burn.
A burn or scald is caused, for example, by:
- Open fire, flames, fire, explosion: classic burns
- Boiling/hot water, steam, oil and other liquids: Scalding
- Hot metal, plastic, coal, glass: contact burns
- Solvents and cleaning agents, concrete, cement: chemical combustion
- Electricity in the home, high-voltage power lines, lightning: electrical burns
- Sun, solarium, radiation treatments using UV and X-rays: Radiation combustion
In addition, a burn may also result from contact with certain plants such as giant hogweed or hot water bottles and heating pads.
The heat causes the cell protein of the body cells to coagulate. The cells perish and the surrounding tissue may die (coagulation necrosis). Finally, inflammation-promoting messenger substances (prostaglandins, histamine, bradykinin) and stress hormones are released, which make the blood vessel walls more permeable (increase in permeability).
Fluid flows from the bloodstream into the tissue and causes it to swell. This results in so-called edema. Fluid leakage from the blood vessels is highest in the first six to eight hours and lasts for up to 24 hours.
Effects on the body
In the course of edema formation, the amount of circulating blood (volume deficiency, hypovolemia) in the bloodstream is reduced. As a result, organs are no longer sufficiently supplied with blood and oxygen. Ultimately, kidney failure and intestinal undersupply may lead to cardiovascular failure and death.
Afterburn
As a result of the water retention, the tissue surrounding the burn may no longer be supplied with sufficient oxygen, leading to further cell damage. Doctors refer to this as afterburn. Due to the continuing flow of fluid into the tissue, the extent of a burn can usually only be fully assessed after a day.
Burns: diagnosis and examination
- How did the burn occur?
- What caused the burn (e.g. an open fire or a hot object)?
- Did the burn occur at home or at work?
- Did you burn yourself on hot water or hot fat, i.e. did you suffer a scald?
- Was there hot smoke, toxic gases or soot in the air around you?
- Are you in pain?
- Do you feel dizzy or have you briefly lost consciousness?
For minor burns, your family doctor or dermatologist is the right person to contact. Severe burns require treatment by an emergency doctor and then by surgeons.
Physical examination
After the consultation, the doctor will examine the body in detail. In the case of severe burns, for example after a clothing burn, the burn victim will be completely undressed.
The doctor will also measure blood pressure, pulse and respiratory rate and monitor the heart’s performance, which is particularly affected by electrical accidents. Finally, the doctor will listen to the lungs (auscultation), take blood samples and take an X-ray of the lungs.
Needle test
Blood test
Certain blood values provide information about inflammation, blood loss and fluid deficiency as well as respiratory function. In the case of inhalation trauma, there is usually a high level of carbon monoxide in the blood, which inhibits oxygen transport in particular.
In addition, inflammatory messengers (e.g. interleukins IL-1,-2,-8 and tumor necrosis factor alpha) can be detected in the blood in severe burns. Since a burn victim also loses proteins through the burn wound, the protein content in the blood is reduced in severe burns.
While the sodium content is usually reduced, the potassium content increases due to the cell damage.
Bronchoscopy for airway burns
In the case of burns to the airways, the doctor performs a bronchoscopy. Using a flexible, thin tube with a camera at the end, the doctor makes deeper regions visible.
In the case of inhalation trauma, traces of soot and whitish-grey areas can be found there, indicating that cells have died off. The examination of lung mucus (tracheal secretion) also indicates a possible burn if the doctor finds soot particles in it, for example.
Estimating the extent of the burn
According to this, the arms each take up nine percent of the body surface area, the legs, torso and back each take up 18 percent (twice nine percent), the head and neck nine percent and the genital area one percent.
According to the palm rule, the palm of a patient’s hand accounts for approximately one percent of the total body surface area.
Both rules are only rough estimates that need to be adjusted, especially for small children and infants. For example, an infant’s head accounts for 20 percent of the body surface area, while the torso and back only account for 15 percent each.
Accompanying injuries
During the physical examination, the doctor will look for other injuries such as broken bones or internal bleeding and, if necessary, will arrange for further examinations such as a CT scan or ultrasound.
If an infection of the burn wound with bacteria is suspected, a swab of the wound is taken and the exact pathogen is determined. Adequate tetanus vaccination is always important. After basic immunization, a booster vaccination is recommended after ten years at the latest.
Course of the disease and prognosis
Infants and children are more susceptible to complications following a burn than adults. A burn is particularly life-threatening if around 15 percent of an adult’s body surface (at least grade 2b) is damaged – children are at risk from eight to ten percent.
If left untreated, severe burns lead to cardiovascular failure and death.
Estimating the prognosis
There are two systems that can be used to estimate the healing process of a burn victim. The Banx index, which is considered outdated, involves adding the percentage of body surface area burned to the patient’s age. According to this index, the probability of survival is less than ten percent for values above one hundred.
The so-called ABSI score, which takes several factors into account, is more accurate. In addition to age and extent, the presence of an airway burn, third-degree burns and the patient’s gender also play a role.
However, the ABSI score also disregards certain risk factors. This is because, according to recent medical studies, nicotine and alcohol consumption also reduce the probability of survival in addition to concomitant or pre-existing conditions such as diabetes, obesity, wound healing disorders and increased susceptibility to infection.
Healing prospects
A 2nd degree burn heals after about a month, although pronounced scars may form. A 1st degree burn, on the other hand, heals without consequences.
During wound healing, so-called hypertrophic scars may form. This is possible, for example, if the site of the burn has been inflamed for a long time or if the wound is deep.
After a burn, it is possible for the doctor to transplant tissue as part of a transplant (for example in the case of a 3rd degree burn). This may result in distinct scars as well as different skin tones.
How long you are off sick or on sick leave after a 1st, 2nd, 3rd or 4th degree burn varies from person to person, as the duration depends on the severity of the burn, among other things. Severe burns require treatment in specialized centers.
Prevention
Many burn accidents are caused by carelessness. Prevention plays a particularly important role in the case of burns caused by electricity. Safety measures at workplaces at risk are constantly being improved. Information on safety precautions and regular maintenance work are also aimed at protecting against electrical burns.
If there are small children in the household, it is important to close hot, open oven doors and put boiling pots or burning candles out of reach. This will reduce the risk of scalding or burns.
