When skin burns, cell destruction occurs to the layers of the skin and the burn victim experiences depletion of vital fluids and electrolytes. Depending on the depth and size of the burn, whether the injury is localized or extensive, it may affect the skin layers and even underlying tissue. The degree of burn identifies the extent of injury and the associated medical complications. Causes of burns include thermal sources such as flames, hot liquids or steam, chemical sources such as strong acids, electrical sources such as high-voltage currents and radiation sources such as ultraviolet light and X-rays. According to MedlinePlus, thermal burns are the most common.
First Degree
Burn injuries affecting the epidermis, or the outer layer of skin, are called superficial-thickness burns, or first degree burns. The blood vessels in the skin which are located within the dermis, the second layer of skin, remain intact. First degree burns involve mild to severe redness in the affected area without the presence of blisters. According to the Nemours Foundation, mild swelling occurs along with pain and redness in the burned area. The skin may also blanch with pressure and healing occurs within three to six days.
Second Degree
Second degree burns have two subtypes: superficial partial-thickness burn and deep-partial thickness burn. Generally, in a second degree burn, the injury goes beyond the epidermis into the dermis layer, while the subtypes indicate how much of the dermis is actually affected. According to the book "Medical-Surgical Nursing: Critical Thinking for Collaborative Care," superficial partial-thickness burns cause large blisters, swelling and a wet, shiny surface on the skin. On the other hand, deep partial-thickness burns cause no blister because the dead tissue layer sticks to the underlying dermis. Also, the swelling is moderate with the injured surface appearing dry and red with white areas in the deeper parts. Additionally, MedlinePlus states second degree burns are painful because nerve endings lie within the dermis of skin.
Third Degree
The most serious types of burns are classified as third degree burns. Clinically, third degree burns are further typed into full-thickness or deep full-thickness burns, both types indicating destruction of the epidermis and dermis and extending to the underlying tissues. Eschar, or hard, inelastic dead tissue that appears dry and leathery, occurs with third degree burns and it must be removed before any healing can start.
With full-thickness burns, the skin may appear white, deep red, yellow or black as well as dry with swelling present underneath the eschar. Full-thickness also means the epidermis and dermis are completely destroyed so the pain may be extremely reduced or even completely absent. The Nemours Foundation states that this is due to damaged nerve endings.
In deep full-thickness burns, the injury extends beyond the skin into the underlying tissues including the fascia, or connective tissue, and damages muscles, bone and tendons, according to "Medical-Surgical Nursing: Critical Thinking for Collaborative Care." The injured area will appear black with eschar and sensation will be completely absent. According to the Nemours Foundation, third degree burns most likely require treatment with skin grafting, a surgery in which healthy skin from another part of the body is placed on the wound for healing.
References
- U.S. National Library of Medicine and National Institutes of Health: MedlinePlus: Burns
- Nemours Foundation: KidsHealth: Burns
- "Medical-Surgical Nursing: Critical Thinking for Collaborative Care"; Donna Ignatavicius; 2006
