2nd degree burn

When a diagnosis of a second-degree burn is made, this means that damage to the skin has affected not only the upper stratum corneum of the epithelium, but also the underlying epidermal layers (eleidin, granular, spinous), but the destruction has not affected the cells of the basal layer.

And although a second-degree burn is considered a moderate injury in terms of the depth of tissue damage, when its area exceeds the size of a person's palm (i.e. 1% of the entire skin surface), it is recommended to consult a doctor. It should be borne in mind that even a smaller second-degree burn in a child or an elderly person can be very serious.

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Epidemiology

According to the Global Burden of Disease review, 35 million people worldwide suffered burn injuries (without specifying the severity) in 2013. This resulted in almost 3 million hospitalizations and 238,000 deaths.

Experts have found that the most common causes of burns are: fire (44%), scalding (33%), hot objects (9%), electricity (4%), chemicals (3%). At the same time, most (69%) burns are received at home, as well as at work (9%).

Second- and third-degree burns from boiling water and other hot liquids are most common in children under five years of age; in the United States, Canada, Europe, and Australia, childhood burns account for about two-thirds of all burn injuries. And contact with hot objects is the cause of about 25% of all burns in childhood.

Chemicals cause 2-11% of all burns, but at the same time account for almost 30% of all fatalities. The causes of two-thirds of fatalities are associated with the development of septicopyemia and septicocemia.

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Causes 2nd degree burns

The main causes of second-degree burns are the damaging effects on the skin of various parts of the body of high temperatures (open fire) or contact of the skin with objects heated to a high temperature, steam, boiling or very hot liquids, as well as aggressive chemicals or radiation.

Depending on the type of the source of action, the following types of burns are distinguished: 2nd degree thermal burn (2nd degree fire burn, 2nd degree boiling water burn, etc.), 2nd degree chemical burn (acid, alkali or heavy metal salts), and radiation burn of the skin. True, 2nd degree sunburns are rare: as a rule, these are superficial 1st degree burns. But with very light skin, especially in blondes and redheads, the second degree of UV burn can be a consequence of excessive use of a solarium.

As experts note, a second-degree burn in a child aged one to three years is a consequence of scalding with boiling water in more than 65 cases out of 100.

Thermal or chemical burns of the hand are most often of the 2nd degree – including 2nd degree burn of the hand and 2nd degree burn of the palm. Despite the fact that the epidermis on the palms is thicker and denser (due to a higher content of the keratin protein DKK1 secreted by dermal fibroblasts), an extensive 2nd degree burn of the palm is an extremely painful injury, since the palmar surfaces of the hands and the fingertips contain the largest number of nerve receptors.

A second-degree leg burn or only a second-degree foot burn is also most often thermal, and the risk factors here are the same: careless handling of boiling water or hot oil (leading to scalding), open fire, unprotected heating devices or aggressive liquids.

A second-degree facial burn can be caused by boiling water or steam, acid or alkali, a quartz lamp or electric welding. This skin damage can occur with an improperly performed chemical facial cleansing procedure, for which phenol-containing substances are used. Facial skin burns occur with iodine, hydrogen peroxide, potassium permanganate; a second-degree burn from bodyagi is possible when using its powder as a skin cleanser.

According to clinical statistics, second-degree eye burns occur due to careless handling of chemicals, flammable liquids, or explosive or flammable objects.

Esophageal burn of the 2nd degree – with damage not only to the mucous membrane, but also to the muscle tissue of its walls – the result of swallowing concentrated acids, alkalis, phenol-containing liquids, etc. Read more in the publication – Chemical burns of the esophagus

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Pathogenesis

Local processes that occur in tissues under the influence of hyperthermia or chemicals determine the pathogenesis of burn injury.

A coagulation zone is formed near the center of action: protein cells of the epidermis begin to lose their heteropolymer structure due to denaturation. Irreversible necrosis occurs in this zone, the degree of which depends on both the temperature (or concentration of the chemical substance) and the duration of action.

In addition, the destruction of cell membranes causes cells to lose potassium and absorb water and sodium from the intercellular matrix. And increased permeability of the vessel walls leads to an increase in the amount of intercellular fluid, which causes significant swelling in a second-degree burn.

Immediately around the necrosis, an ischemic zone appears, in which, due to damage to the capillaries, blood flow is sharply reduced, and the cells suffer from a lack of oxygen. In the absence of adequate medical care, the ischemic zone can progress to complete necrosis.

On the periphery of the burn there is a third zone – a zone of hyperemia with a reversible increase in blood flow and inflammation, which develops when T cells, leukotrienes, neutrophils, platelets, monocytes, etc. are activated.

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Symptoms 2nd degree burns

Symptoms of a second-degree burn include pain, redness, swelling, severe tenderness of the skin to the touch, and blisters. The very first signs are a burning pain and erythema of the burned area.

The main distinguishing feature of a second-degree burn is the peeling off of the upper layer of the epidermis and the rapid formation of one or more blisters underneath, filled with a transparent yellowish exudate. A couple of days after the injury, the fluid in the blisters becomes cloudy: insoluble denatured protein and dead leukocytes are mixed in with it. The blisters may leak and spontaneously open, revealing an eroded, bright pink or red burn area that looks wet and shiny.

According to experts, when the burn area is large, then due to the disruption of the thermoregulatory function of the skin, the temperature in 2nd degree burns can rise, and patients experience fever.

When infected, the burned area turns purple in color, the surrounding skin feels hot and swollen, and the wound may ooze a greenish ichor containing pus.

Second-degree sunburns are characterized by distinct hyperemia of the skin and its contact soreness, while blisters and swelling of the adjacent areas appear a little later. Many people with this degree of skin damage from sun rays experience a deterioration in health with nausea and an increase in body temperature.

Complications and consequences

Any burn leads to a decrease in the activity of the tissue macrophage system due to a lack of fibronectin, an adhesive glycoprotein of the extracellular matrix synthesized by epithelial cells. Without it, phagocytes cannot bind to the cells of pathogenic bacteria in order to destroy them by phagocytosis. This is why tissue immunity in burn patients is sharply weakened.

Combustiologists claim that the most common complications of burns are associated with microbial invasion of the burn wound, and its result is an infected second-degree burn, in which subcutaneous phlegmon and streptococcal or staphylococcal pyoderma can develop.

Scars and marks from second-degree burns can be an aggravating consequence of burns to the extremities (especially the hands and feet), since scar tissue – due to the formation of joint and tendon contractures – can limit their mobility. And scars from burns on the face lead to significant cosmetic defects.

If the burn area is large enough (up to 20-25%), life-threatening consequences for the victim are caused by dehydration: the body loses fluid, which is indicated by symptoms such as thirst, dizziness (especially when changing body position), dry skin and decreased diuresis.

How do 2nd degree burns heal?

If the burn wound is not infected (which is the most favorable option), then the synthesis of polypeptide growth factors is activated under the scab formed on its surface, which initiates the accelerated development of growth cells of the basal membrane, that is, the restoration of the skin after a 2nd degree burn or reparative regeneration is launched.

In this case, the stages of healing of a 2nd degree burn include cellular regeneration by proliferation, and then differentiation of cambial cells into keratinocytes, fibroblasts, melanocytes, etc. This takes an average of 10-12 days. Epithelialization ends with the formation of a new stratum corneum of the epidermis. In this case, there is no scar, and after some time, the skin area with altered pigmentation at the site of the burn takes on an almost normal appearance.

An infected second-degree burn heals differently, accompanied by purulent necrosis and inflammation. At the site of necrosis, after the wound is cleansed of dead tissue, a scab forms, under which granulation tissue is formed: within two to three weeks, it fills the skin defect. Granulation tissue is fibrous in structure; then it is transformed into mature connective tissue consisting of fibers of the fibrillar protein collagen. Therefore, when burned skin surfaces become infected, scars and cicatrices of second-degree burns are formed.

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Diagnostics 2nd degree burns

Diagnosis of a second-degree burn is carried out by visually examining the site of injury and determining its location and origin.

As a result, the doctor must determine the degree of the burn (i.e. the depth of tissue damage) and its total area - as a percentage of the entire surface of the skin. The intensity of the pain syndrome, the level of tissue swelling and signs of infection are assessed. The treatment tactics and prevention of possible complications will depend on the combination of these clinical factors.

If the surface of a second-degree burn is significant, blood tests (complete clinical) are taken, as well as a detailed urine analysis for an objective assessment of general homeostasis.

Instrumental diagnostics using an ophthalmoscope is used for eye burns, and X-rays of the gastrointestinal tract are necessary when an esophageal burn is suspected.

Differential diagnosis

The task performed by differential diagnostics is to distinguish a 2nd degree burn from a 3A degree burn, which also produces blisters.

Treatment 2nd degree burns

In adults and children over five years of age, treatment of a 2nd degree burn with an area of >15%, as well as a 2nd degree burn covering more than 5% of the skin in a child under five years of age and an adult over 60, is carried out in a medical institution. Any 2nd degree burns of areas such as arms, legs, face (especially eyes), groin, also require hospitalization. In the hospital, an anti-tetanus injection is mandatory and pain relief is administered.

First aid for 2nd degree burns

It is necessary to follow the sequence of actions that includes first aid for 2nd degree burns:

• without delay, the action of the damaging agent or contact with the source of thermal or any other burn is stopped and an ambulance is called;
• the burned area is cooled with cold water (+16-17°C) for a quarter of an hour (ice and water below +10°C cannot be used);
• if the burn is chemical, the liquid chemical is washed off in the same way (with a large volume of running water at t +12-15°C) (sulfuric acid is first dried with a dry cloth); the powdered chemical is first removed dry. More information in the article - What to do in case of a chemical burn
• any painkiller in tablet form is taken;
• a dry sterile bandage is applied to the burn surface, the large affected area is covered with sterile gauze pads;
• If the victim does not vomit, he is given water with added table salt (half a teaspoon per 0.5 l).

Treatment begins with cleaning the burn surface with water and treating it with antiseptics: 2-3% hydrogen peroxide or furacilin solution, chlorhexidine or miramistin solution. And the undamaged skin around the burn is disinfected with alcohol-containing agents.

Small blisters formed by a second-degree burn are not opened, but large ones should be opened by a doctor with a sterile instrument. After the exudate comes out, medications are applied to the damaged area (covered by exfoliated epithelium) and a bandage is applied. The removal of the exfoliated skin, which served as the outer wall of the burn blister, is also performed by a surgeon - provided that the exudate is cloudy. Any independent manipulations with burn blisters are strictly contraindicated due to the high risk of developing a suppurative process.

Treatment of a second-degree burn after opening the blister involves the use of antimicrobial drugs and agents that promote skin reparation.

Antibiotics for second-degree burns of minor size are prescribed locally - applied directly to the wound surface or to a bandage.

It should be immediately emphasized that in modern combustiology, ointments for second-degree burns are used not with a vaseline base, but based on high-molecular hydrophilic homopolymers (PEO).

The following have proven to be effective:

• Antibacterial anti-inflammatory ointment Levomekol for 2nd degree burns, containing chloramphenicol (levomycetin) and the regenerating agent methyluracil; the drug is applied to the burnt area or a bandage soaked in it is applied (once a day).
• Combined ointment Levosin (with chloramphenicol, sulfadimethoxine, methyluracil and anesthetic trimecaine).
• Antimicrobial ointment with silver sulfadiazine (Sulfadiazine, Sulfagin, Dermazin, Argosulfan). The drug is not used in case of significant exudate secretion and kidney and liver problems, in children under three months and pregnant women. Possible side effects include allergies, decreased white blood cell count, kidney inflammation and tissue necrosis.
• Ointment with streptocide and nitazole Streptonitol and 0.1% gentamicin ointment (used for infected burns once or twice a day).

The list, which includes medications for external use to improve tissue trophism and stimulate skin regeneration, is headed by Panthenol ointment for 2nd degree burns - based on provitamin B5 dexpanthenol. This product is also available in the form of Panthenol anti-burn aerosol. More information - Ointment for burns

Ophthalmologists treat second-degree eye burns in a comprehensive manner, including with the help of eye drops such as Okomistin (Oftamirin) and Thiotriazolin.

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Caring for a 2nd degree burn

The main thing that care for a second-degree burn requires is to follow the rules of antisepsis to minimize the occurrence of a secondary infection.

Many people wonder whether it is possible to wash a 2nd degree burn? If it is not recommended to change dressings often for uncomplicated burns (it is enough to do this every 5-6 days), then there can be no talk of washing the burn surface. This also applies to cases when the patient has an infected burn.

It is considered optimal to change the dressing (with treating the damage with antiseptics and applying the next dose of ointment) after it has become wet. Special antibacterial absorbent dressings for 2nd degree (and 3rd degree) burns – Mepilex Ag, Atrauman Ag, Silkofix, Fibrotul Ag, Fibrosorb, Aquacel Ag Burn Hydrofiber (including in the form of gloves – to more effectively treat a burn of the hand or palm) – facilitate care of the burn and help reduce the risk of infection.

Each time any dressing is changed, the wound should be examined and its condition assessed, since the appearance of purulent inflammation does not exclude the need for surgical treatment.

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Surgical treatment

To avoid large-scale suppuration and the entry of necrosis products of dead tissue into the systemic bloodstream, and also to ensure that skin recovery after a second-degree burn occurs as physiologically as possible, surgical sanitation of the burn surface is performed - necrectomy.

Surgical treatment for these burns is the layer-by-layer removal of dead tissue, which is most often used for extensive burn damage to the skin (more than 15-20%).

If necessary, the wound is simultaneously closed using dermo-epidermal autografts, and xenografts are used to stimulate the processes of epithelialization and skin reparation.

Homeopathy, physiotherapy, vitamin therapy

When prescribing homotoxic agents, the constitutional type and character of the person are taken into account; few people turn to homeopaths for burns. Homeopathy recommends such agents for the treatment of second-degree burns as Arnica 30 (mountain arnica), Aconit 30 (aconite), Cantharis 30 (Spanish fly extract, taken orally every hour until the pain syndrome disappears), Sulphuricum acidum 30 (sulfuric acid) and Urtica urens (stinging nettle extract).

Anti-inflammatory and analgesic homeopathic ointment Traumeel S can also be used for second-degree burns, which is applied to the healing wound under a bandage (but it can cause hyperemia of the skin and itching).

Physicians use physiotherapy in cases of extensive burns. The main methods include magnetotherapy, UHF therapy, local hyperoxygenation and barotherapy. Thalassotherapy is used for post-burn scars, and massage and exercise therapy are used for contractures.

It is recommended to additionally take vitamins A, C and E. The first two promote collagen production; vitamin C reduces tissue fluid requirements and helps reduce swelling; vitamin E (400-800 IU per day) promotes healing.

Treatment of 2nd degree burns at home

Treatment of 2nd degree burns at home is possible only for small areas of damage. So, if a scalded finger is treated at home, then a burn of the hand is treated on an outpatient basis, and a burn of the entire hand is treated in the hospital.

The medications and principles of care for a burn wound are the same. True, some recommend folk treatment with cabbage leaves, pumpkin, potato (with sour cream) or carrot compresses. I also advise smearing the burn with raw egg white or sprinkling with eggshell powder…

It is more advisable to carry out treatment with herbs and medicinal plants such as aloe, Kalanchoe and golden mustache.

Minor burns can be treated with compresses with decoctions of calendula, plantain, St. John's wort, fireweed, snakeweed, meadowsweet, lingonberry leaves (a tablespoon per glass of water). However, herbal compresses are not applied to an open wound. Dry kelp (seaweed) steamed with boiling water can be applied to sunburn.

The burnt surface is irrigated several times a day with the juice of aloe leaves, Kalanchoe, golden mustache or solutions of mumiyo and propolis.

Nutrition for 2nd degree burns

The key rules on which nutrition for burns is based are: sufficient amounts of liquid (1.5 liters per day) and food rich in proteins.

Nutrition is one of the main components of recovery for patients with burn injuries. With burns, the need for proteins increases due to protein loss through the burn wound. According to calculations by nutrition experts, it is necessary to consume 1.5-2 grams of protein per kilogram of body weight daily, that is, at least 25% of the daily calorie intake. Foods high in protein include meat, poultry, fish, nuts, seeds, dairy products, and eggs.

The diet should contain enough carbohydrates: firstly, it is a source of glucose (stimulating the synthesis of fibrillar proteins), and secondly, carbohydrates prevent the use of muscle protein as an energy source.

Fats – butter, cream, fatty fish – are necessary in the diet for burns to provide the body with essential fatty acids. But fats should not be more than 30% of the daily calorie intake, as their excess can weaken the immune system.

Prevention

Is it possible to prevent burn injuries? Theoretically, it is possible – if everyone strictly follows safety rules at work and at home. But in practice, a mother is often working in the kitchen near a burning stove, and a small child is nearby. Or containers with dangerous substances are located where the same child can take them and open the lid – just like that, out of curiosity…

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Forecast

Of course, if more than 10% of the skin is damaged, after contacting a medical facility you will receive not only adequate treatment, but also sick leave for a second-degree burn.

But keep in mind that the prognosis for burns is considered favorable only if the skin is damaged by 30%, up to 60% is conditionally favorable, and anything higher (and in children - higher than 40-45%) is problematic and unfavorable.