Second Degree Burns

Generality

Second-degree burns are lesions involving the surface of the skin and the layer of tissue immediately below. These are characterized by an intense skin inflammation, in which pain, burning, swelling and formation of blisters or blisters ( flittene ) rapidly take over.

The healing of second-degree burns is very slow. The less serious lesions resolve completely within a few weeks, without scars, but with possible pigmentary outcomes (ie the damaged skin area appears darker). In the case of involvement of the deep dermis, on the other hand, the healing times are longer and permanent signs remain.

The causes of second-degree burns include direct contact or exposure to heat, electricity, radiation and chemicals .

Treatment depends on the severity of the accident and the extent of the skin surface involved. In any case, to avoid serious consequences, it is advisable to contact a specialized hospital immediately.

What are

Second-degree burns (also called dermal burns) are traumatic lesions affecting the most superficial part of the skin ( epidermis ) and the underlying tissue layer ( dermis ) at varying depths.

How the skin is made

The skin is the largest organ and represents the largest part of the body in contact with the external environment.
The skin surface is not just a simple shell, but carries out a series of fundamental functions for the organism: it protects from external aggressions (such as traumas), regulates body temperature, promotes the absorption of important substances, etc.
The skin appears as a thin fabric, covered with hair and small imperfections. In reality, this is composed of three main layers, each of which performs different functions and, in turn, are divided into further zones:
- Epidermis (most superficial layer): it is the external scaffolding of the skin and there are germinative cells, involved in the production of all the skin components.
- Derma (intermediate part): it is formed by connective tissue, soft and elastic. The dermis is crossed by capillaries, lymphatic vessels and nerve receptors (papillary layer). Moreover, it allows the skin to remain elastic and taut, allowing adequate protection of the whole body (reticular layer).
- Hypoderm or subcutaneous (innermost layer): it connects the dermis and the epidermis to the internal tissues, allowing the anchorage on muscles and bones and favoring the adherence of the skin during the movement of the body.

Second-degree burns are very painful. In addition to appearing red and swollen, the skin also has more or less extensive blisters, full of serous fluid.

Depending on the extent of the damage, second degree burns can be distinguished into:

Superficial dermal burns : they involve the upper part of the dermis, therefore there is an interruption of the epidermis basement membrane with partial involvement of the papillary layer. These are typical lesions from contact with hot liquids or brief direct exposure to fire.
Deep dermal burns : they also damage the reticular layer of the dermis, but without extension to the subcutaneous tissues. These injuries frequently result from direct exposure to flames.

Second-degree burns involve the partial or total destruction of intradermal epithelial structures, which have the ability to regenerate the skin. This makes the healing times shorter or shorter.

Causes

Second-degree burns are tissue injuries caused by the action of:

Physical / thermal agents : direct contact with open flames, excessive heat produced by the fire, red-hot metal bodies (such as the iron or stoves), vapors, boiling liquids (such as water boiled or oil frying) or other very hot items;
Chemical or caustic substances : ex. bleach, muriatic acid, ammonia and caustic soda;
Electricity : electric shocks, electrical cables and appliances;
Radiation : too long exposure to X-rays, radioactive substances or ultraviolet light, including that of the sun and tanning lamps.

Gravity of a burn

The factors that influence the severity of a second degree burn are:

Degree of depth (level of involvement of the epidermis and underlying layers);
Percentage of the total body surface affected by the lesions;
Part of the body involved.

Warning! If the second degree burn affects more than 15% of the body surface area (10% in the case of children), urgent hospitalization is always required in a specialized hospital. In these cases, in fact, serious complications could arise which can also be fatal for the patient. When burns affect less than 15% of the total surface, medical intervention is still needed for appropriate therapeutic management, but hospitalization may not be necessary.

The extent of second-degree burns also varies according to the characteristics of the causal agent, namely:

Temperature intensity (the higher it is, the greater the damage);
Exposure time (the burn is deeper, the longer the contact with the heat source lasts);
Specific heat and type of burn substance (liquid burns are more extensive, while those from solids tend to be localized, but deeper);

Warning! When second-degree burns are severe or involve delicate parts of the body (eyes, mouth, nose, ears, abdomen, joints and genitals), it is necessary to promptly contact the emergency room : only a doctor knows how to operate in these circumstances, without causing further damage.

Symptoms and Complications

Second-degree burns occur immediately with:

Redness of the skin (erythema);
Swelling (edema);
Very intense burning pain, which lasts over time;
Skin hypersensitivity and contact pain;
Area overheating;
Vesicles or bubbles, raised and filled with straw liquid.

Superficial second-degree burns

Burns involving the superficial and middle dermis can be very painful. The marked reddening of the area is accompanied by the development of blisters or bubbles (note: the size of these lesions based on the extent of the damage); these formations collect in the skin thickness the serum material coming from the capillaries damaged by the burning agent.

When the vesicles open out, it remains a pink-translucent lesion and the area is very painful.

The healing times are very variable and depend on the health of the subject and the extent of the wound. In general, superficial second-degree burns may undergo their resolution in 10-15 days; the regeneration process of the skin starts from the less damaged peripheral areas, leaving a slight hyperpigmentation (spontaneous resolution).

When the lesion extends deep, however, healing is slower (it takes from 2 to 4 weeks) and scars may remain.

Deep second degree burns

Dermal burns that also affect the reticular layer of the dermis (ie the deepest) can take up to 4 months to heal. In these lesions, often, the vesicles are not found, since the dermis has been damaged to the point of not having a thickness that allows the detachment and the collection of the transudate typical of the bladders.

The areas affected by deep second-degree burns are blackened or whitish, dry and not very painful.

Possible consequences

The impairment of the skin barrier associated with second degree burn, may predispose to the onset of infections .
Over the years, the reiteration of a burn in the injured area can increase the risk of developing skin cancers . For this reason, the resulting scars should be monitored throughout the patient's life.
If the damage is very extensive, both on the surface and in depth, a state of general suffering can be established, called " burn shock ".

Diagnosis

Diagnosis of second-degree burns involves anamnesis and physical examination of the affected area.

To define the severity of the injury, the doctor will evaluate the following aspects:

Extension of the burn on the body surface and degree of depth (level of involvement of the epidermis and of the underlying layers) ;
Possible involvement of delicate parts of the body that require immediate treatment (such as eye, nose and mouth);
Signs of infection (pus leakage or severe swelling).

When to seek medical attention urgently

For all the most serious burns and those on delicate parts of the body, such as the face and abdomen;
For burns of any magnitude when the patient is an elderly person, a chronic disease carrier or a child under 3 years of age);
For burns caused by chemicals and electricity (the damage could be more serious than is evident);
In case of delay in healing, despite the care given to the wound;
During the course, the burn shows signs of infection or deterioration.

Therapy

Unlike first-degree burns, second-degree burns always require the intervention of a doctor to avoid complications, such as deep scars or skin infections.

First intervention

Pending the intervention of the doctor and / or hospitalization, it is necessary to cool the burned part: the skin has the property of conserving heat, therefore the first operation must aim to lower the temperature of the affected area.

Even when the injured part has been removed from the heat source, in fact, the damage to the skin continues. The cold interrupts this destructive process, as well as having a pain-relieving effect.

The injured part can be cooled by immersing it in a basin of fresh water (at about 15 ° C) or by keeping it under the open tap, until the pain disappears (indicatively for 5-15 minutes). Instead, the application of ice directly on the area should be avoided, as it could aggravate the burn.

Warning! In case of contact with chemical substances (eg quicklime), absolutely avoid contact with water, as this could cause greater damage.

In the presence of second-degree burns, to avoid further traumatizing the area, it is advisable to carefully remove any clothing or accessories such as rings, bracelets and necklaces. If the clothes have remained attached to the skin, however, do not try to detach them: this operation can only be conducted by medical specialists.

drugs

The treatment involves the use of medicines to be taken orally and / or applied locally, in order to reduce pain and speed up the healing process, favoring skin regeneration.

The systemic drugs most commonly indicated for the management of second-degree burns include:

Antipyretics to be taken in case of fever (eg paracetamol);
Non-steroidal anti- inflammatory drugs (NSAIDs) with analgesic activity, such as ibuprofen, diclofenac or ketoprofen.

The topical management of second-degree burns has the task of facilitating healing and protecting the injured party. For this purpose, the doctor can indicate the application of medicated gauze or specific ointments, containing substances, such as hyaluronic acid or phytostimulines, which accelerate the process of skin regeneration.

At the beginning, the dressing will be renewed daily to detect the progress of the reparative processes; afterwards, it should be replaced every 3-4 days until healing, always carefully disinfecting the part, to avoid the risk of infections. For the same reason, when blisters form, you must absolutely avoid piercing them. In this way skin integrity would be interrupted, compromising the defense against infectious agents.

In case of intense and persistent pain, however, it is possible to resort to the local application of products with anesthetic action, containing, for example, benzocaine or lidocaine .

In self-medication of second-degree burns, it is important to keep the affected part as sterile as possible. In order to prevent infectious complications, careful cleansing and accurate disinfection of the lesions with antiseptic, non-alcoholic solutions based on iodopovidone, electrolytic chloride oxidants or chlorhexidine is advised. On prescription from the doctor, in case of suspected infection or for simple prevention, finally, antibiotic therapy (local or systemic) may be indicated.

Surgical interventions

Deep second degree burns may necessitate incision injuries and implantation of grafts (cutaneous or synthetic) to facilitate healing and decrease the risk of infection. The outcomes of the lesions (eg keloids) can be corrected with plastic surgery.

What to do

Remove the burning agent;
Cool the affected area immediately with fresh water;
Protect damaged areas.

What NOT to do

Never try to remove the clothes adhering to the burned area (in addition to clothing you run the risk of removing the skin, worsening the situation);
Do not pierce or remove the bubbles present (this produces pain and predisposes to infection);
Never underestimate a second-degree burn: a very extensive superficial lesion can be as dangerous as one of limited size, but profound. Pay attention to the injury especially if it is slow to heal or affects very young children, the elderly and those with chronic diseases (eg diabetes);
Do not apply any home remedies, such as oil or butter, to the burned area. These substances slow down the healing process and, unlike specific preparations, are not sterile, so they can predispose to infections;
Do not use antibiotic creams without first consulting your doctor;
Do not use boric acid and denatured alcohol for wound care;
Do not compress the area affected by the second degree burn.