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Second Degree Burns
Second Degree Burns
A second degree burn, also called a partial thickness burn, is a burn that affects the dermis without penetrating deep enough to affect the hypodermis. Most second degree burns come from the same sources as first degree burns but are the result of prolonged exposure to the burn source. Chemical and electrical burns are also a common source of second-degree burns.
Second-degree burns can be further broken down into two sub-classifications, superficial and deep. The distinction between superficial and deep burns is how far into the dermis the burn penetrates.
Superficial second-degree burns penetrate only to the stratum papillare—the upper layer of the dermis. This is the layer of the dermis comprised primarily of connective tissues that connects the dermis to the epidermis. While the term “superficial” may make these burns seem harmless, they can still be extremely painful and may require medical attention.
Deep second degree burns penetrate through the upper dermis and into the stratum reticulare—the lower layer of the dermis. This layer contains a majority of the bodies sensory receptors which makes deep second degree burns the most painful burns that someone can experience. This layer also contains hair roots, sweat glands, and blood vessels. Deep second degree burns can permanently affect hair growth and oil production in the affected areas and lead to long term scarring. Burns this deep also take about twice as long to heal as superficial second-degree burns.
Pain: The five senses help the body understand what is going on in the world around it. Pain fills a similar role within the body and is an important tool for survival. It’s the body’s way of informing the brain that something is wrong. Pain causes us to recoil from surfaces that are hot and tells us to avoid putting weight on a broken foot. Without pain, we could cause serious damage to our bodies without realizing it.
The nervous system is the way in which pain is transmitted to the brain. The dermis contains nerves that are sensitive to the body’s functions. If some function is not acting properly, nerves relay this information to the spine through an electronic signal. Because nerves are so sensitive, one of the epidermises functions is to protect the nerves from receiving stimuli that would cause false pain signals.
Second-degree burns destroy the epidermis’s ability to perform this function. The nerves become exposed or damaged and begin sending an increased number of signals to the brain. The brain receives these signals and interprets them as severe pain. Because of the severity of the pain, over-the-counter medication may not be sufficient to control the pain.
Blisters: The most indicative sign of a second-degree burn is the formation of blisters. Blisters are a natural reaction to severe irritation and inflammation within the skin. The body sends fluid to the surface of the skin to act as a protective shield against further damage. Some of that moisture collects into rapidly constructed flaps of thin skin that form blisters.
Weeping: Moisture which isn’t captured in blisters makes its way to the surface of the skin. The epidermis is too damaged to retain the moisture, so the moisture seeps out making the burn appear wet.
Coloration: Second-degree burns appear deep red but turn white when pressure is applied. The red color comes from the body’s release of histamines which dilates the capillaries causing excess blood to come to the surface of the skin, exactly the same as a first-degree burn. When pressure is applied, blood is forced out of the capillaries. This process is called blanching. Under normal conditions, blood flow should return to the skin as soon as the pressure is alleviated. Second-degree burns damage the blood capillaries and cause inflammation making it more difficult for blood to return to the surface. This gives the skin a white appearance until blood returns to the area.
Peeling: Peeling occurs when a burn damages living cells in the dermis. The body is forced to discard these dead cells resulting in peeling. Because there are more living cells in the dermis than in the epidermis, second-degree burns tend to peel more extensively than first degree burns.
In a few discrete circumstances—such as superficial second degree burns less than 3 inches in diameter—second degree burns can be treated at home, but they are prone to infection and can lead to serious complications if not properly cared for. When treating a second degree burn on your own, use all of the same care and precautions that you would for a first degree burn.
Additionally, take extra precautions to avoid infection because the epidermis’s ability to guard against infection is drastically compromised. Remove jewelry in the vicinity of the burn site as it can harbor germs and tear open the fragile skin. Wash your hands thoroughly before cleansing the burn area and avoid touching the burn with your hands directly. Instead, use sterilized cleaning utensils when cleaning the affected area.
Avoid popping blisters. Blisters act as a temporary replacement for the damaged epidermis. Popped blisters create an open wound that is easily irritated and even more susceptible to infection. Open blisters may also cause additional weeping which in turn will require more frequent bandage changes.
Second degree burns often require professional medical treatment. Burns located on the face, feet, genitals, or hands have the potential to cause long-term scarring or mobility impairment if not properly treated. Medical professionals have the training and equipment to assess the severity of the burn and determine what further treatment may be required. They are also suited to assist with combatting other medical complications that can arise as a result of a second degree burn.
Regardless of any complicating factors, pain alone is often a factor that necessitates professional medical treatment. Over-the-counter pain medication works by attacking the secondary effects of pain. When the brain receives pain signals from the nervous system, it tells the body to start forming enzymes to assist in the repair process. These enzymes lead to swelling and can cause additional pain. Over-the-counter pain relievers work to limit the production of these enzymes which reduces swelling and pain.
Medical professionals may be able to prescribe pain relievers that are able to better target the pain directly. Anticonvulsants target the nervous system directly and can limit the ability of nerves to send signals to the brain. Opioid painkillers work by blocking pain receptors in the brain, again targeting pain at the nervous system level. These methods are more effective at managing pain but are also accompanied by more serious side effects. Because of the potential dangers of the side effects, professional medical attention is required before these forms of pain relievers are used.
In some cases, second degree burns may require more advanced medical procedures. Specific treatment should be evaluated on a case-by-case basis using the following considerations:
- The age of the patient: burns can interfere with childhood development and growth in young children; older patients are at an increased risk for complications that should be monitored by medical professionals.
- The extent of the burn: when burns cover a large portion of the body, determined by total body surface area, the body is less capable of healing on its own.
- Source of the burn: electrical burns have the potential in interfering with the body’s electrical system or internal organs without leaving much visible damage; chemicals can similarly lead to non-burn complications, such as poisoning. Medical tests may be necessary to test for these complications.