Home Diseases Burns: definition, treatment, home remedies

Burns: definition, treatment, home remedies

by Josephine Andrews
Published: Last Updated on 302 views

In the case of a burn, the skin is damaged by the effects of heat. Most burns are only superficial. In severe cases (burn illness) intensive medical treatment is necessary. Read everything you need to know about burns and what helps with burns here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

T23 W87 T20 T27 X19 T24 T21 T22 T30 T28 T31

quick overview

  • Treatment: Varies depending on the severity or depth of the burn
  • Causes and risk factors: Strong heat effects (eg contact with hot liquids, flames, radiation)
  • Symptoms: pain, blistering, skin discoloration, loss of pain sensation, etc.  
  • Diagnosis: Questioning (anamnesis), physical examination, blood tests, needle sampling, bronchoscopy
  • Course of the disease and prognosis: Depends on the depth and extent of the burn, age, previous illnesses and concomitant injuries
  • Prevention: Safe handling of electrical devices and open fire, precautionary measures, education

What are burns and what are the degrees?

A burn is damage to the skin caused by direct exposure to heat. Contact with hot liquids is called scalding. Hot or heated objects trigger so-called contact burns.

Chemical accidents result in chemical burns or chemical burns. Burns caused by electric current (electrocution) are referred to as electrical burns. UVA or UVB and X-rays cause so-called radiation burns.

A burn occurs, among other things, on the face, lips, mouth, palate and other parts of the body. The hand may also be completely or partially (individual fingers) affected by a burn.

In severe cases one speaks of the so-called burn disease. This occurs in adults with a large-scale burn of more than 15 percent and in children more than 10 percent.

Burn disease is typically characterized by phases of shock, edema reabsorption, and inflammation/infection.

frequencies

Every year in Europe, millions of people with burns are treated by general practitioners and thousands are treated as inpatients in clinics. Many of them require intensive care 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 (eg deflagration after an explosion). In contrast, scalding occurs most frequently in children and the elderly. Burns mostly 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. In addition, the epidermis protects the body from drying out.

It wears out easily, but is constantly being reproduced by deeper cells. A small, ie light burn, is usually limited to the epidermis. The outermost defense cells of the immune system are also located at the border to the underlying dermis.

The dermis (corium) lies directly beneath the epidermis. Finely ramified skin-supplying blood vessels, muscle strands and nerves run here. The upper cells of the dermis are more active than the lower ones. Therefore, a superficial dermis burn heals more easily than a deeper one.

Underneath is the hypodermis (subcutis), which consists of fatty tissue and is traversed by larger blood vessels and nerves.

Depending on the depth of a burn, burns are divided into four degrees (degrees of burn):

First degree burn

In the case of a first-degree burn, the burn is limited to the epidermis, usually only to the superficial horny layer (stratum corneum).

2nd degree burn

A second degree burn damages the skin down to the top layer of corium. Read everything you need to know about second degree burns here.

Third degree burn

Third-degree burns can occur on various parts of the body (eg face), damage the entire epidermis and extend into the subcutis.

4th degree burn

A fourth-degree burn chars all layers of the skin and often involves the underlying muscle tissue, bones, tendons, and joints.

How are burns treated?

Regardless of whether a burn or scald is caused by fire, radiation or laser treatment, filling a hot-water bottle or other causes – burns are often uncomfortable, sometimes even life-threatening and should be treated accordingly.

Treatment depends on the severity of the burn. First degree and second degree type a burns are usually treated conservatively, ie with medication. Burn treatment includes:

  • cooling
  • wound cleansing
  • Application of special antiseptic preparations
  • Creating a bandage

In the case of burns from the 2nd degree type b, further treatment steps may be required, such as an operation to remove dead tissue or to transplant skin ( transplantation ).

Follow-up care for burns may also include the use of special plasters to care for scars.

What to do with burns Read everything you need to know about treating  burns, treating scalds and relieving pain here.

Which home remedies help?

Home remedies may help with a burn, but their effectiveness is often not scientifically proven. It is assumed that poultices with chamomile blossoms 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, do not get better or even get worse, you should always consult a doctor.

Burn: Symptoms

The symptoms of a burn or scald depend primarily on the depth: the deeper the burn extends, the more the sensation of pain is lost.

In the case of particularly deep burns, some patients no longer feel any pain at all because the nerve endings are burned along with 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 off (vacuolating degeneration).

An open burn is weeping because fluid is leaking from the blood stream. In the early phase after a burn, the skin or 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 supplied with sufficient blood and oxygen. Patients complain of dizziness or even lose consciousness.

Ultimately, a major burn injury may result in life-threatening shock (burn shock). Typical symptoms include noticeably low blood pressure, a very fast beating heart (palpitations, tachycardia), cold, pale arms and legs, and metabolic disorders. The reduced blood flow to the organs can lead to their failure.

Depending on the degree of burns, the following symptoms may occur:

degree of combustion

symptoms

I

Pain, swelling (oedema), redness (erythema), burning like sunburn

II a

severe pain, blistering, skin appears pink at the burn site (pink bottom of the wound), 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.

Irreversible tissue death (necrosis) occurs.

IV

Body areas completely black charred, no pain

scalding

Tough (viscous) liquids store heat better and often damage the skin more in the event of scalding than, for example, water. Different degrees of burns usually occur at the same time. So-called run-off marks are often recognizable.

inhalation trauma

Breathing in hot gases or air mixtures can damage the airways. This so-called inhalation trauma usually has an unfavorable effect on the general healing process of the patient.

Burns on the head and neck, burned-off nose and eyebrow hair and traces of soot in the ear, nose and throat area indicate such damage. Those affected are usually hoarse, have difficulty breathing and cough up soot.

electro burn

Electrical burns occur when the body is exposed to an electrical current, such as from lightning. Since the body offers a natural resistance to electricity, heat develops – the greater the resistance, the greater the heat generation.

Since the bones offer a great deal of resistance, muscle tissue in the vicinity is usually destroyed. The severity of an electrical burn also depends on the type of current, the current flow and the duration of contact. In most cases, only a small, inconspicuous skin wound appears through which electrical current has entered the body.

Causes and risk factors

Burns and scalds occur when the body is exposed to intense heat. Tissue is destroyed at temperatures above 44 degrees Celsius. Values ​​above 40 degrees Celsius are sufficient for prolonged exposure to heat. In addition to the temperature, the duration of the heat effect is a major factor in the development of a burn.

A burn or scald occurs, for example, as a result of:

  • Open fire, flames, fire, explosion: classic combustion
  • Boiling/hot water, steam, oil and other liquids: scalding
  • Hot metal, plastic, charcoal, glass: contact burns
  • Solvents and cleaning agents, concrete, cement: chemical combustion
  • Household electricity, high-voltage power lines, lightning: electrical burns
  • Sunbathing, solarium , UV and X-ray radiation treatments: radiation burns

In addition, a burn may also result from contact with certain plants such as giant hogweed (Hercules perennial) or hot water bottles and heating pads.

tissue death

The cell protein in the body cells coagulates as a result of the heat applied. The cells perish and the surrounding tissue eventually dies (coagulation necrosis). Finally, pro-inflammatory messenger substances (prostaglandins, histamine, bradykinin) and stress hormones are released, which make the blood vessel walls more permeable (increase in permeability).

Fluid rushes from the bloodstream into the tissue, causing it to swell. So-called edema develops. The leakage of fluid from the blood vessels is highest in the first six to eight hours and lasts up to 24 hours.

effects on the body

In the course of edema formation, the amount of circulating blood (deficiency in volume, hypovolemia) in the bloodstream decreases. As a result, organs are no longer supplied with sufficient blood and oxygen. Ultimately, kidney failure and intestinal malnutrition can lead to cardiovascular failure and death.

afterburn

Due to the water retention, the tissue around the burn may no longer be adequately supplied with oxygen and further cell damage occurs. Doctors refer to this as an afterburn. Due to the continuous flow of fluid into the tissue, the extent of a burn can usually only be fully assessed after a day.

Combustion: diagnosis and investigation

A visual diagnosis is usually sufficient for the initial assessment of a burn. However, the circumstances under which the burn injury occurred are also important. Your doctor will therefore ask you questions about your symptoms as well as questions about how the accident happened:

  • How did it burn?
  • What caused the burn (e.g. an open fire or a hot object)?
  • Did the burn occur at home or at work?
  • Have you been burned by hot water or hot fat , ie scalded?
  • Was there hot smoke, toxic gases, or soot in the air around you?
  • Do you have pain?
  • Do you feel dizzy or have you lost consciousness for a short time?

For minor burns, your family doctor or dermatologist (skin doctor) is the right person to talk to. Serious burns require treatment by an ambulance and then by surgeons.

Physical examination

After the patient consultation, the doctor examines the body in detail. In the case of severe burns, for example after a clothing fire, the burn victim is completely undressed.

In addition, the doctor will measure blood pressure, heart rate and the frequency of breathing, as well as monitor the work capacity of the heart, which is particularly affected by electrical accidents. Finally, the doctor listens to the lungs ( Auscultation), takes blood and makes an X-ray of the lungs.

pinpoint

Distinguishing a second-degree burn from a third-degree burn is usually difficult at first. This can only be achieved after about 24 hours. The prick with a needle helps. With a third-degree burn, the patient feels no pain from the sting.

blood test

Certain blood values ​​provide information about inflammation, blood loss and dehydration as well as respiratory function. In the case of an inhalation trauma, there is usually a high proportion of carbon monoxide in the blood, which in particular inhibits the transport of oxygen.

In addition, inflammatory messengers (e.g. interleukins IL-1,-2,-8 and tumor necrosis factor alpha) can be detected in the blood of severe burns. Since a burn victim also loses protein through the burn, the protein content in the blood is reduced in the case of severe burns.

While the sodium content is usually reduced, the potassium content increases due to cell damage.

Bronchoscopy in airway burns

In the case of burns in the airways, the doctor performs a lung examination. Using a flexible, thin tube with a camera at the end, the doctor makes deeper lying regions visible.

In the case of an inhalation trauma, traces of soot and whitish-grey areas are found there, which indicate cell death. The examination of lung mucus (tracheal secretion) also indicates a possible burn if the doctor finds soot particles in it, for example.

Estimation of the extent of the burn

Especially in the first few days after a major burn, the doctor closely monitors the progress and carries out some examinations again. To estimate the extent of a burn, he uses Wallace’s so-called rule of nine.

Accordingly, the arms each take up nine percent of the body surface, legs, torso and back each 18 percent (twice nine percent), head and neck nine percent and the genital area one percent.

According to the palm rule, the palm of a patient’s hand is about one percent of the total body surface.

Both rules are only rough estimates that need to be adjusted, especially for small children and infants. For example, an infant’s head makes up 20 percent of the body’s surface area, while the torso and back only make up 15 percent each.

associated injuries

During the physical examination, the doctor looks for other injuries such as broken bones or internal bleeding and will arrange for further examinations, such as computed tomography or an ultrasound , if necessary.

If there is a suspicion of an infection of the burn with bacteria, a smear of the wound is taken and the exact pathogen is determined. Basically, an adequate tetanus vaccination protection is important. After the basic immunization, a booster vaccination is recommended after ten years at the latest.

Course of the disease and prognosis

The healing process of a burn depends primarily on the depth and extent of the burned body surfaces. Pre-existing conditions, an advanced age of the person concerned and concomitant injuries such as organ damage reduce the chances of recovery.

Infants and children are more prone to complications after a burn than adults. A burn becomes life-threatening in particular when around 15 percent of the body surface of an adult is damaged (at least degree 2b) – children are already threatened at eight to ten percent.

Left untreated, severe burns lead to cardiovascular failure and death.

Estimation of the prognosis

There are two systems that can be used to estimate the healing process of a burn victim. With the Banx index, which is considered outdated, the percentage of burned body surface is added to the patient’s age. According to this index, the probability of survival is less than ten percent for values ​​over one hundred.

The so-called ABSI score, which takes several factors into account, is more precise. In addition to age and extent, the presence of a respiratory burn, third-degree burns and the patient’s gender also play a role.

But even with the ABSI score, certain risk factors are ignored. According to recent medical studies, nicotine and alcohol consumption reduce the probability of survival in addition to concomitant or previous illnesses such as diabetes, obesity (obesity), wound healing disorders and increased susceptibility to infections.

chance of recovery

Depending on the depth of the burn, it may take several weeks or months to heal. For example, the healing time for a first-degree burn differs significantly from that for a third-degree burn.

A second-degree burn will heal in about a month, with pronounced scars forming under certain circumstances. A first-degree burn, on the other hand, heals without consequences.

In the context of wound healing, so-called hypertrophic scars may occur. This is possible, for example, if the burn site has been inflamed for a long time or if the wound is deep.

After a burn, it’s possible for the doctor to transplant tissue as part of a transplant (for example, a third-degree burn). In addition to clear scars, there may also be different skin tones.

How long you are ill or on sick leave after a 1st, 2nd, 3rd or 4th degree burn varies from person to person, since the duration depends, among other things, on the severity of the burn. Severe burn injuries require treatment in specialized centers.

Prevent

Many burn accidents are caused by careless actions. Prevention plays a particularly important role in burns caused by electricity. In this way, safety measures at workplaces that are at risk are constantly being improved. Education about safety precautions and regular maintenance work are also aimed at protecting against electrical burns.

It is also possible to prevent burns in the home with a few simple measures. Always turn off the power before doing electrical work and use flammable materials such as denatured alcohol appropriately. Don’t smoke in bed.

When there are small children in the household, it is important to close hot, open oven doors and put boiling pots or lit candles out of reach. This reduces the risk of scalding or burns.

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