Cell Star

Skin Burns

Skin burns are injuries to the skin and underlying tissues caused by heat, electricity, radiation, chemicals, or friction. Burns can range from mild superficial injuries to deep, life-threatening wounds that involve muscles and bones. They not only cause physical pain and scarring but also have significant psychological and emotional effects.

Burns require prompt assessment and treatment to minimize tissue damage, control infection, and support healing. Depending on severity, treatment may involve first aid, wound care, skin grafting, and advanced regenerative therapies such as stem cell therapy and hyperbaric oxygen therapy (HBOT).

Classification of Burns

Burns are classified based on their depth and the extent of tissue damage:
First-degree burns (superficial):

  • Affect only the outer layer of skin (epidermis)
  • Symptoms: Redness, pain, mild swelling
  • Healing time: 3–7 days without scarring

Second-degree burns (partial thickness):

  • Involve the epidermis and part of the dermis
  • Symptoms: Blisters, intense pain, swelling, wet or shiny appearance
  • Healing time: 2–3 weeks; may leave pigmentation changes or mild scarring

Third-degree burns (full thickness):

  • Extend through the entire dermis and may affect underlying tissues
  • Symptoms: Waxy, white, or charred appearance; no pain due to nerve damage
  • Healing time: Prolonged; usually requires surgical intervention or skin grafts

Fourth-degree burns:

  • Involve muscles, tendons, and bones
  • Symptoms: Blackened, charred skin; life-threatening
  • Require extensive surgical treatment

Burn Severity Assessment

Severity is determined based on:

  • Depth of the burn
  • Total Body Surface Area (TBSA) affected
  • Burn location (face, hands, genitals, major joints)
  • Patient age and pre-existing health conditions
  • Cause of the burn (chemical, electrical, etc.)

Common Causes of Burns

  • Thermal burns: Flames, hot liquids (scalds), steam, or hot objects
  • Chemical burns: Acids, alkalis, industrial chemicals
  • Electrical burns: Current entering and exiting the body, often causing deep internal damage
  • Radiation burns: Sunburn or exposure to radiation therapy
  • Friction burns: Abrasions combined with heat, such as road rash

Initial First Aid for Burns

  • Remove the source of heat or chemical
  • Cool the burn with running water for 10–20 minutes
  • Avoid using ice or oily substances
  • Cover with a sterile, non-stick bandage
  • Do not pop blisters or remove stuck clothing
  • Seek immediate medical help for severe burns

Diagnosis and Evaluation

  • Physical examination and burn area measurement (Rule of Nines or Lund-Browder chart)
  • Blood tests to monitor organ function in severe burns
  • Imaging for electrical burns or suspected inhalation injury
  • Bronchoscopy for airway assessment in inhalation injuries

Conventional Treatment

Wound care:

  • Cleaning and debridement of necrotic tissue
  • Application of antimicrobial dressings (e.g., silver sulfadiazine)
  • Use of hydrocolloid or hydrogel dressings for moisture retention

Pain management:

  • NSAIDs, opioids, or sedatives as needed

Fluid resuscitation:

  • Especially important in burns involving >20% TBSA
  • Parkland formula used to calculate fluid requirements

Infection control:

  • Tetanus prophylaxis
  • Systemic antibiotics for infected wounds

Nutritional support:

  • High-calorie, high-protein diets to support healing
  • Enteral nutrition in extensive burns

Surgical treatment:

  • Escharotomy or fasciotomy for compartment syndrome
  • Skin grafting using autografts, allografts, or synthetic grafts

Rehabilitation:

  • Physical therapy to prevent contractures and maintain mobility
  • Occupational therapy and psychological support

Stem Cell Therapy in Burn Management

Stem cell therapy offers promising results for enhancing wound healing and skin regeneration.

  • Mesenchymal stem cells (MSCs) from bone marrow, adipose tissue, or umbilical cord
  • Epidermal stem cells

Mechanism of action:

  • Promote angiogenesis (new blood vessel formation)
  • Enhance fibroblast and keratinocyte activity for skin regeneration
  • Modulate inflammation and prevent excessive scarring

Clinical applications:

  • Used with bioengineered scaffolds or hydrogels for wound coverage
  • Can be applied topically or injected at the wound site

Evidence:

  • Clinical studies report faster epithelialization, reduced pain, and improved cosmetic outcomes

Hyperbaric Oxygen Therapy (HBOT) for Burns

HBOT supports burn healing by enhancing oxygen delivery to hypoxic tissues.
Mechanism:

  • Increases oxygen tension in plasma and tissues
  • Stimulates angiogenesis and collagen synthesis
  • Reduces edema and inflammation
  • Enhances neutrophil function and bacterial clearance

Indications:

  • Deep second- and third-degree burns
  • Carbon monoxide poisoning from smoke inhalation
  • Compartment syndrome and ischemic wounds

Treatment regimen:

  • Typically involves 90–120 minute sessions, once or twice daily

Benefits:

  • Faster healing
  • Reduced infection rates
  • Better graft survival and reduced scarring

Prevention of Burns

  • Install smoke alarms and fire extinguishers at home
  • Keep hot objects and chemicals away from children
  • Use protective gear in high-risk work environments
  • Follow safety guidelines for electrical and chemical handling
  • Avoid prolonged sun exposure and use sunscreen

Long-term Complications

  • Scarring and keloids
  • Contractures leading to mobility restrictions
  • Chronic pain and itching
  • Disfigurement and psychological trauma
  • Increased risk of infection and sepsis
  • Hypothermia and fluid imbalance in extensive burns

Psychosocial Support

  • Burns can cause significant emotional distress, anxiety, and PTSD
  • Support groups, counseling, and occupational therapy help patients reintegrate into daily life

Conclusion

Skin burns are serious injuries that require immediate and comprehensive care. While first-degree burns can be managed at home, deep and extensive burns need specialized intervention. Advances in wound care, surgical techniques, and regenerative medicine—such as stem cell therapy and HBOT—have transformed burn management, improving survival and aesthetic outcomes. A multidisciplinary approach involving medical treatment, rehabilitation, nutrition, and psychological support ensures the best possible recovery for…