A dermatitis of various intensity may be caused by the
action of excessive heat on the skin, or if this heat is extreme the integument
with underlying tissue may even be destroyed. The changes in the skin due to
dry heat or scalding are so similar that they both may arbitrarily be
classified into three degrees. A first degree burn of the skin results merely in
an active congestion of the superficial blood vessels causing an erythema which
is followed by epidermal desquamation. Ordinary sunburn is the most common
example of a first degree burn. The pain and increased surface heat may be
severe and it is not rare to have some constitutional reaction when the
involved area is large. When the burn is of second degree there is a
transudation of serum from the capillaries which causes edema of the
superficial tissues. Vesicles and blebs are formed by the serum gathering
beneath the outer layers of the epidermis. Complete recovery, without scar
formation or other blemish, occurs in burns of both these two degrees. Third
degree burns are far more serious in nature as there is actual loss of tissue
of the full thickness of the skin and even some of the subcutaneous tissues;
and an ulcerating wound is produced which in healing leaves a scar. Third
degree burns are almost always surrounded by burned areas of lesser intensity.
All third degree burns are followed
by constitutional symptoms of varied gravity, their severity depending upon the
size of the involved surface, the depth of the burn, and particularly the
location of the burned surface. It appears that the more vascular the involved
area is, the more severe are the symptoms. There are symptoms which are the
result of shock appearing within twenty-four hours after the patient is burned.
These are followed by symptoms produced by toxemia from absorption of destroyed
tissue on the surface of the wound. Lastly, there may be symptoms from wound
infection, the result of contamination with pyogenic organisms. The symptoms of
these three conditions may merge so that differentiation is difficult.
The prognosis as to life is poor in any case where a large
area of skin surface is involved. It is almost hopeless if a fourth of the body
surface is burned. Complicating conditions are not at all uncommon in the more
severe cases of burns. In addition to the infection of the wound and
surrounding cutaneous tissue with cellulitis or erysipelas, the patient may
develop an acute duodenal ulcer or glomerulonephritis as well as pulmonary or
meningeal lesions.
The local
results of third degree burns are often unsatisfactory if not treated in a
proper manner. Excessive scarring, both keloid-like scars or flat scars with
contractures, may produce deformities of the joints and dysfunctions as well as
chronic ulcerations due to impairment of the local circulation. Later changes
of a malignant nature in the scar may result in an epithelioma. With modern
plastic surgery these unfortunate end results can be prevented.
Local treatment
consists of thorough cleansing of the burned area, removal of necrotic tissue,
spraying with Aerosol solution of streptomycin and penicillin and the
application of petrolatum gauze dressings. Penicillin and streptomycin are
given intramuscularly at regular intervals to control infection. In severe
cases accompanied by shock transfusions of blood, plasma, and electrolytes are
given. Pain is controlled by one dose of morphine intravenously. Cortisone is
recommended in serious cases. It combats shock and increases the appetite and
epithelization.
First degree
burns, such as sunburn, may when severe be treated with some emollient such as
olive oil, or petrolatum containing 2 per cent benzocaine if there is pain; or
a wet dressing of ice cold milk. The vesicles or blebs of second degree burns
should not be opened but should be protected from injury as they form a natural
barrier against contamination with microorganisms. If they become tense and
unduly painful the fluid may be evacuated under strictly aseptic conditions by
puncturing the wall with a surgical needle and allowing the blister to collapse
upon the underlying wound and then applying a gauze dressing.
Electric burns are of two varieties, contact
and flash. A contact burn is small in area but deep, causing some necrosis of
the underlying tissues which later separates and is thrown off. Flash burns are
usually large in area and are similar to any surface burn and are treated as
such.