A burn is an injury typically of the skin of variable thickness whereby the thicker the injury the greater the propensity for scarring. Burns are caused by extremes of thermal contact whether hot or cold, electricity, chemicals and ultraviolet irradiation.
Approximately 175,000 people per year in the UK attend accident and emergency departments with burn injuries although only about 10% require hospitalisation. Admission is more likely as a result of extensive areas involved, thicker burns, electrical or chemical burns, airway burns, paediatric burns with risk of non-accidental injury and circumferential burns of any body part.
There are three types of burn:
Superficial – involve only the outer layer of skin, the epidermis. These burns are typically red and painful and heal within a few days without scarring such as sunburn.
Partial Thickness – involve the epidermis and varying depth of the dermis. These burns typically blister, are painful and can be blotchy and red but become paler as depth involved increases. These burns can take weeks to heal with a varying degree of scarring as such following a scald with hot water.
Full thickness – the complete thickness of the epidermis and dermis is involved along with deeper tissues such as fat or muscle. The appearance is either of charred tissue or a dry leathery appearance.
Treatment of burns is typically by dousing the affected parts in copious running water and applying a cool compressive bandage.
More complex or extensive wounds require hospital admission for pain relief and complex wound management. Furthermore, as the skin is vital in the prevention of fluid loss and a barrier to infection, the bigger the burn, the greater the risk of fluid loss resulting in shock that requires intensive fluid replacement as well as wound infection. Should the patient become dehydrated or the burn become infected the greater the subsequent scarring following healing will occur.
In the long term the degree of scarring is proportional to the depth of the burn. Superficial burns will not scar unless they become secondarily infected but will remain sensitive to heat and sunlight for several months afterwards so avoidance of heat exposure and sunlight and the use of sunblocks is indicated. Partial thickness burns will scar to some degree but this can be reduced by preventing infection and in the long term using silicone gel preparations and compressive garments. Full thickness burns will inevitably scar and take months to heal, if at all, and therefore are usually surgically excised and the resultant defect skin grafted. These grafts will scar, but again the long term use of compressive garments is essential in reducing scarring.