Burns

Burns are most commonly classified based on their depth. This helps to determine the appropriate initial medical treatment and also affects the long term outcome of the injury. The skin structure can be thought of in 3 layers:

1. Epidermis – the most superficial layer of the skin, which contains different types of skin cells including melanin (i.e colour) producing cells.
2. Dermis – the deeper tissue of the skin ,which contains small blood vessels, nerves and hair follicles.
3. Subcutaneous tissues/fat – the deepest layer which separates the skin from the underlying muscle. It contains larger blood vessels and fatty tissue.

The appearance and symptoms of a burn injury will depend on which skin layer the injury reaches.

• Superficial epidermal burn: this only affects the most superficial layer of the skin. It can be painful and red in appearance but should not cause any blistering.
• Superficial partial thickness burn: this will damage the epidermis and also the top of the dermal layer; it typically causes blistering in addition to pain, swelling and redness.
• Deep partial thickness burn: this is when the burn injury has caused damaged to the epidermis and a large part of the dermis. It can cause pain and blistering, although if it is deep enough, the wound may appear blotchy, dry and painless
• Full thickness burn: these occur when the burn injury has penetrated all 3 layers of the skin. These are typically painless and will appear very pale or leathery.
  Significant burn injuries require prompt and effective first aid measures to prevent the individual from becoming unwell. Due to the breakdown of the skin and its natural properties, those with burn injuries are at a high risk of dehydration and infection until the damaged skin has healed or been repaired.

Once healed, the new skin will be particularly sensitive to sunlight, chemical exposure and temperature, which can all cause additional irritation. It is recommended to look after any burn-related scars by ensuring good skin hygiene, avoiding any products containing irritants, and regular moisturisation with a non-perfumed cream or ointment. Massage techniques can also be helpful in promoting and maintaining good scar quality.

Unfortunately, some individuals experience scarring that causes long term pain or itch. If the injury has occurred over a large area of skin or overlying a joint, the scarring may become contracted and cause problems with movement. Many people with scarring related to burn injuries also experience feelings of low mood or anxiety and can have concerns about their appearance leading to low self-esteem and confidence. Although difficult to treat, there are a number of effective options to help reduce the effects of burns and scarring in the long term. Optimal management often requires the input of a multi-disciplinary team of clinicians who are experienced in managing individuals with burns.

Treatment options to reduce the symptoms and appearance of burns include:

• Topical treatments, such as silicone gels/strips
• Compression garments
• Laser treatments
• Needling sessions
• Steroid injections
• Surgical management, including scar revision surgery, artificial skin, skin grafting and tissue expander treatment. The most appropriate surgical procedure will be dependent on the type, location and associated symptoms of the scarring.

As well as reducing the physical appearance of the scars, it is also important to address any psychological or emotional factors associated with burns injuries, as this can have a significant influence on an individual’s recovery. Some people may also benefit from physiotherapy or occupational therapy to help them return to their normal activities.