Burns are tissue damage usually caused by heat and characterized by redness, swelling, burning sensation and pain. The lowest temperature that can cause a burn is 40°C to 45°C. Burns are most often caused by hot liquids, chemical substances (bases and acids), electricity, flames and excessive sun exposure. Thermal energy can influence the death of skin cells with the release of histamine, prostaglandins and other substances that cause fluid and electrolytes loss and circulatory disturbance.

Burn classification

Burn classification is performed based on the percentage of the burned area (rule of nines), depth, localization and general condition of the injured: 1. Burns of 1st degree and 2ndA degree are superficial, characterized by spontaneous epithelialization without forming scar tissue. Redness, light swelling and pain are present, but the symptoms resolve within 7 to 14 days. These burns can be treated on an outpatient basis, and require special attention if they are located on the face, areas around the joints, genitals and if they encompass more than 10% of the body. 2. Burns of 2ndB degree are more severe, affecting deeper layers of skin, they rarely spontaneously epithelialize and surgical treatment is required. Symptoms include deep redness, pain, blistering, and areas of exposed tissue that are moist due to the outflow of lymph. Since the deeper layer of the skin is damaged, the healing process is longer, there is a greater chance of infection and the formation of unattractive scars on the skin. Sometimes it is necessary to transplant the skin from other parts of the body. 3. Burns of 3rd degree are deep burns that affect the full thickness of the skin and subcutaneous tissue, sometimes to the bones, with disrupted general condition, resulting in shock. They represent an emergency condition and require surgical treatment, fluid and electrolyte compensation. The skin can be charred, dark brown in colour, elevated.

How to perform first aid in case of burns?

Timely and properly provided first aid in case of burns has a great effect on the further course of recovery. It is necessary to quickly eliminate the source causing the burn. The burned surface should be cooled with water of 20°C temperature for 15 to 30 min. All clothes should be removed from the burned body part . It is wrong to use ice, traditional remedies, oil, ointments, which can cause even greater tissue damage. Chemical burns should be rinse with water for 30 minutes, especially burns around the eyes. In case of chemical burns, the antidotes, neutralizers can be administered — if the burn is caused by acid, you should keep a gauze soaked in a solution of baking soda for a couple of hours. If the burn is caused by bases, caustic sodas, apply compresses of 1% solution of acetic acid. Cover the burned surface with sterile gauze or clean cloth. The injured should be given plenty of fluids to drink and pain killers, if necessary. After the first aid is administered, the patient is treated on an outpatient basis or in the hospital depending on the degree of burn and the percentage of the affected area of the skin.

How the burns are treated?

Any burns, regardless of the depth and size, located on the face, joints, hands, feet, genitals require professional medical attention. In case of chemical burns of any degree, hospitalization is required because of the long-term administration of the antidote. If the burns are larger than the surface of the hand or if they are third degree with white or charred skin, they are treated surgically in the department of plastic surgery. All patients with a disorder of the general condition, a state of shock, cough, shortness of breath must contact a physician. Superficial burns after the administered first aid are covered with sterile gauzes to prevent the infection of the injured area. All the time, antibiotic ointments and creams are used to stimulate skin epithelization. Antitetanus protection is mandatory, and systemic antibiotics are administered in case of complications and infection.

What is the treatment for burn scars?

When skin heals after a burn, the unattractive, uneven scars may form. In case of superficial burns after epithelization, only brown stained spots may appear and they can be successfully removed with Q-switch laser in our clinic. Unattractive scars from burns are very successfully treated with a fractionated CO2 laser after several treatments, the damaged tissue is filled up with collagen.
Svetlana Đurišić specijalista dermatovenerologije

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