Burns Support Group

• First-degree burns are usually limited to redness (erythema), a white plaque and minor pain at the site of injury. These burns usually extend only into the epidermis.
• Second-degree burns additionally fill with clear fluid, have superficial blistering of the skin, and can involve more or less pain depending on the level of nerve involvement. Second-degree burns involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis layer.
• Third-degree burns additionally have charring of the skin, and produce hard, leather-like eschars. An eschar is a scab that has separated from the unaffected part of the body. Frequently, there is also purple fluid. These types of burns are often painless (insensate) because nerve endings have been destroyed in the involved areas.

A newer classification of "Superficial Thickness", "Partial Thickness" (which is divided into superficial and deep categories) and "Full Thickness" relates more precisely to the epidermis, dermis and subcutaneous layers of skin and is used to guide treatment and predict outcome.

Serious burns, especially if they cover large areas of the body, can cause death; any hint of burn injury to the lungs, for example through smoke inhalation, is a medical emergency.

Chemical burns are usually caused by chemical compounds, such as sodium hydroxide (lye), silver nitrate, and more serious compounds (such as sulfuric acid). Note that most chemicals (but not all) that can cause moderate to severe chemical burns are strong acids or bases. Nitric acid is possibly one of the worst burn-causing chemicals, as an oxidizer. Hydrofluoric acid can eat down to the bone and its burns are often not immediately evident. Most chemicals that can cause moderate to severe chemical burns are called caustic.

Electrical burns are generally symptoms of electrocution, being struck by lightning, being defibrillated or cardioverted without conductive gel, etc. The internal injuries sustained may be disproportionate to the size of the "burns" seen - as these are only the entry and exit wounds of the electrical current.

Survival and outcome (scars, contractures, complications) of severe burn injuries is remarkably improved if the patient is treated in a specialized burn center/unit rather than a hospital.

Burns are assessed in terms of total body surface area (TBSA), which is the percentage affected by partial thickness or full thickness burns (superficial thickness burns are not counted). The rule of nines is used as a quick and useful way to estimate the affected TBSA.