Second Degree Burns

When the epidermis and part of the dermis of the skin are involved in any burn injury, it is known as a second-degree burn. Depending on the level of nerve involvement, the severity of the pain varies in second-degree burns. In the case of second-degree burns, in addition to superficial blistering, there is accumulation of clear liquid in the area. Involving superficial or papillary dermis, second-degree burns sometimes involve the reticular or deep layer of the dermis.

When the skin experiences any burn or surface damage, the surrounding layer of the skin expands resulting in a blister. The Plasma or serum is released as the result of the damaged Keratinocytes - outermost layer of the skin. The released plasma /serum helps to prevent further damage and also to help in the healing process. This is the reason why blisters should not be punctured as it would invite infection to the affected skin. The serous fluid will be reabsorbed by the skin usually after 24 hours if there is no infection.

According to the severity of these burns, they are further classified as deep or superficial. When only the outermost part of the dermis is involved, it is called superficial. Extreme pain and hypersensitivity to touch are characteristics of superficial burns. Appearing moist and red or mottled pink in color, the skin at the area of the burn blanches on pressure. Usually blisters appear after some time. Normally, this kind of superficial second - degree or partial thickness burns heal by themselves.

Blood Blister : This ensues when a part of the skin is pinched or crushed with force. The capillaries affected by the force rupture leaking blood into the skin.

Tissue destruction to the deeper layers of the dermis is involved in deep second - degree and deep partial thickness burns. In contrast to the superficial type, these deep second -degree burns are usually dry and whitish in appearance, but they may appear like superficial burns. Normally pain is associated with this type of burns, though the skin does not blanch. It may take three to four weeks for the burn to heal. Thick or hypertrophic scars may remain even after the injury heals.

Causes of a second-degree burn include scald injuries, flames and a brief contact of the skin with a hot object. Sometimes deep sunburn, contact with hot liquids or chemicals and burning gasoline or kerosene also may cause second-degree burns. With second degree burns, the skin color turns to deep red and you will notice blisters. The burnt area appears shiny and moist. Second-degree burns that are only superficial normally heal in about three weeks. Care should be taken to keep the wound clean and protected. For effective treatment of second degree burns, the following conditions are considered:

• The medical history, overall health and the age of the patient
  
• To what extent the burn has damaged the skin
  
• Site of the burn
  
• Incident that caused the burn
  

Person affected by burns of this type may go into shock, since they lose lots of fluid from the burned site, if the injury involves more than 10% of skin. If a second-degree burn is greater than 2 or 3 inches in diameter, only a medical professional should treat it. It is safe to treat a burn like this at home only when it is a smaller. According to the severity of the burn, treatment may vary from antibiotic ointments to systemic antibiotics. Every day cleaning of the wound is necessary to remove dead skin. Depending on the severity of the burn, the dressing should be changed at least once or twice a day. It may be painful for the patient when the dressing is changed. A pain reliever or analgesic will help to reduce the pain. Care should be taken not to burst any blisters that have formed.

First Aid for second-degree burns

• Before the area begins to swell, tight clothing and jewelry should be removed.
  
• Cold-water compresses like a wet towel can be applied or flushing the burn with cool running water may also help to lessen the pain. Using ice or ice water can do more harm to the burned area and should be avoided.
  
• Do not try to burst the blisters. Breaking blisters will expose the skin which will lead to infection.
  
• Covering the burn with a sterile, non-fluffy and dry bandage can be done, but tapes should not be used on top of it.
  
• Ointments, grease, petroleum jelly, butter or any home remedies are better avoided.
  
• By keeping the burned arms or legs raised, you can reduce swelling.
  
• Getting medical help is the best for second-degree burns greater than 2 to 3 inches in diameter or for those on hands, buttocks, penis or vaginal region.

When there are open blisters following second-degree burns:

• If the clothing is stuck to the burn, better not remove them.
  
• Running water over the burn or using water on the bandage will increase the risk of shock and so do not do it.
  
• You can cover the burn with a clean, dry, non-fluffy bandage like gauze pad, but do not use tapes on the bandage.
  Get the help of a doctor if the burn is very extensive and more than 2 to 3 inches in diameter.
  

Third degree burns

Every layer of the skin is involved in third-degree burns. Even after the treatment, only the edges heal because they are so deep. If skin grafting is not carried out, in the long run the burned area will be covered with scars. Affecting the epidermis, dermis and hypodermis, third-degree burns cause charring of the skin. The skin appears white and translucent and you can see coagulated vessels just beneath the skin surface. Even though the burned areas may be numb, there may be some pain. This may be due to associated with it. Since the skin tissue and the structures are destroyed, healing from third-degree burns is very slow. New skin will not grow in this area since the epidermis and hair follicles are destroyed.

Third degree burns occur when clothing coming into contact with fire or corrosive chemicals. Accidental contact with hot objects, flames or electricity can cause third degree burns. The skin turns white or it may turn black or brown and leathery. Though little pain may be experienced in the burned area because nerve endings have been destroyed, pain will be more in the surrounding areas. Some of the other symptoms that are noticed include redness, peeling skin, shock and pale clammy skin associated with weakness, bluish lips and nails.

Medical treatment is necessary for all third-degree burns. If you notice a person's clothes burning ask him or her not to run in panic. It will aggravate the flames and they may rise even up to the person's face. With the help of a blanket, jacket or rug you can suppress the flames all along rolling the person on the ground. If the clothing has stuck to the burn do not try to remove it. Applying ice water, lotions, sprays, ointments or home remedies is not advisable.

Since swelling is a possibility, remove jewelry and tight clothing from the burned. In order to bring the body temperature back to normal, apply cold moist cloths for brief periods or immerse the burned area in cold water. Care should be taken for not to leave the burned area in cold water too long for it will result in cooling down the body very much. There may be signs of shock such as rapid or faint pulse, nausea and vomiting and rapid and shallow breathing. Call for medical help if the person undergoes shock. Unless it is warranted do not move the person. In case vomiting occurs, the person should be asked to lye on their side to prevent choking. Keep the feet raised unless the person has breathing problems. In order to conserve body heat, cover the person with a blanket. You can give small sips of water or clear juice, if the person remains conscious and if the medical help may require some time to reach, provided there is no vomiting. Moistening the lips will do if the person is in shock since drinking more water will induce vomiting. Never give alcohol to a person who is in shock.

Chemical burns: Clothing and jewelry on which the chemical has spilled should be removed. With running water, wash out liquid chemicals for 15 to 20 minutes avoiding splashing the chemical in the eyes. If large amounts of water are not available immediately, clear dry chemicals away from the skin since some chemicals get activated by small quantity of water. A dry and loose bandage can be given to cover the burn.

Electric burns: A health care provider should be called for to examine any electrical burn. Though an electrical burn may seem to cause little damage, because it extends deeply into the tissues underneath the skin the damage may be more. For many hours the damage may not surface. The burned area may be covered with a dry, non-fluffy loose bandage. Applying any ointment or other substances should be strictly avoided.

Hospitalization may be required for a few days or for several weeks for third-degree burns and scars. Depending on the severity of the burns, several operations by a medical plastic surgeon may be required to get rid of the scars. Treatment at a burn center is usually necessary for wide spread burns.

Benign nevi

Also known as a mole, nevi is a benign growth that could appear like hyperpigmentation of the skin, colored macules, plaques or papules. Nevi are mostly congenital. They are confined to a particular area of the skin. They are also commonly referred to as birthmarks or beauty marks. Benign nevi typically means that the specific pigmented skin portion has not shown any signs of abnormality that is typical of skin cancer.

How do nevi occur?

Development of nevi is influenced by age of the person, environmental factors like sun exposure, race and genetic factors. It can develop in any part of the body though it can be predominant in sun-exposed areas like arms, face or neck when compared to intermittently exposed areas like chest, back or legs. Though most nevi are benign, 25% of malignant melanoma arise from pre-existing nevi.

For males, nevi are concentrated on the face and neck while for females nevi are concentrated on thighs and upper arms. Dark skinned individuals have a low count of total body nevus when compared to light skinned individuals. However dark skinned individuals develop nevi on the palms and soles. Nevi count in males is higher than in females. Nevi count in children depends on the nevi count in their parents. Commonly acquired nevi follow the ABCDE rule:

Nevi can be classified into different types as listed below

Connective tissue nevus: This type is very rare to occur; they are fleshy deep nodules.

Epidermal nevus: They are present at birth (congenital), and appear on the upper torso of the body. They resemble the color of flesh and appear raised or like a wart.

Nevus sebaceous: A variant of epidermal nevus, it appears on the scalp. The affected scalp area becomes hairless and looks yellowish in color. Melanocytic nevus: Benign production of melanocytes i.e. the skin cells make the brown pigment melanin. Therefore most of the nevi are brown to black in color. They are the common type of nevi and are present in almost all adults. They could be congenital or may develop at a later stage in life. Different types under melanocytic nevus are:

Acquired melanocytic nevus: Acquired at a later stage in life; will not be present in birth or near birth period.

Congenital nevus: Present from birth or near birth.

Dysplastic nevus: Acquired type of melanocytic nevus and difficult to differentiate from melanoma. It could be an indicator for the risk of developing melanoma.

Nevi are grouped based on their location. The different categories are:

Compound: They are hyper pigmented macules located in the epidermis and dermis.

Junctional: They are hyper pigmented macules located in the epidermis.

Intradermal: They are brown/skin colored papules located in the dermis layer.

Diagnosis and treatment of nevi

Diagnosis of nevi is generally done through visual examination; a dermatoscope may also be used. While diagnosing nevi, the main concern lies in identifying a benign nevus from a dysplastic nevus and melanoma. If physical examination doesn't suffice, a skin biopsy may help in identification.

Treatment for benign nevi

In general, benign nevi need not be treated. However a few may want it to be treated for cosmetic reasons. You can opt for laser treatment with a qualified skin specialist.

Protecting skin with nevi

• Wear a sunscreen that is waterproof with a SPF that suits your skin type and climatic conditions.
  
  
• Use a sunscreen with UVA and UVB protection.
  
  
• Minimize outdoor exposure under direct sunlight.
  
  
• Wear a hat to shade your face
  
  
• Wear sun glasses
  
  
• Wear protective clothing.