Second degree burn

When a diagnosis is made - a burn of 2 degrees, this means that the damage to the skin affected not only the upper horny layer of the epithelium, but also the underlying epidermal layers (eleidinous, granular, prickly), but the cells of the basal layer did not affect the destruction.

And although the 2nd degree burn in the depth of tissue damage is recognized as a moderate injury, but when its area exceeds the size of the human palm (ie 1% of the entire surface of the skin), 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.

[1], [2]

Epidemiology

According to the Global Burden of Disease survey, in 2013, 35 million people around the world received burn injuries (without indicating the degree of severity). This led to the hospitalization of almost 3 million people and 238,000 deaths.

Experts 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 of the (69%) burns people receive at home, as well as at work (9%).

Burns with 2 and 3 degree boiling water and other hot liquids are the most common in children under the age of five; in the USA, Canada, European countries and Australia, the share of child burns accounts for about two-thirds of all burn injuries. And contact with hot objects causes about 25% of all burns in childhood.

Chemicals cause 2-11% of all burns, but they give almost 30% of all deaths. The causes of two thirds of deaths are associated with the development of septicopyemia and septiccoemia.

[3], [4], [5], [6],

Causes 2nd degree burn

The key causes of the 2nd degree burn are damage to the skin of various parts of the body at high temperatures (open fire) or skin contact with objects heated to high temperature, steam, boiling or very hot liquids, and aggressive chemicals or radiations.

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

As specialists note, the second degree burn in a child aged between one and three years is the result of scalding with boiling water in more than 65 cases out of 100.

Thermic or chemical are most often burned hands of 2 degrees - including, burn the brush of grade 2 and burn the palm of the 2nd degree. Although the epidermis is thicker and denser on the palms of the palms (due to the higher content of keratin protein DKK1 secreted by the dermal fibroblasts), an extensive burn of the palm of the 2nd degree is an extremely painful injury, since on the palm surfaces of the hands and on the finger pads the largest number of nerve receptors.

A 2-degree foot burn or only 2-degree foot burn is also more often thermal, and the risk factors here are the same: careless handling of boiling water or hot oil (resulting in scalding), open fire, unprotected heating devices or corrosive liquids.

The face 2 degree burn can be obtained with boiling water or steam, acid or alkali, quartz lamp or electric welding. This skin damage can occur with an improperly performed face cleansing procedure for which phenol-containing substances are used. There are skin burns of the face with iodine, hydrogen peroxide, potassium permanganate; It does not exclude a burn from a 2 degree water spray when using its powder as a skin cleanser.

According to clinical statistics, eye burn of the 2nd degree arises from careless handling of chemicals, combustible liquids or explosive or flammable objects.

Burning of the esophagus of the 2nd degree - with damage not only to the mucous membrane, but also to the muscular tissues of its walls - the result of ingesting concentrated acids, alkalis, phenol-containing liquids, and the like. 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, cause the pathogenesis of burn damage.

Near the center of the impact, a coagulation zone is formed: the epidermal protein cells begin to lose their heteropolymer structure due to denaturation. In this zone there is irreversible necrosis, the degree of which depends both on the temperature (or concentration of the chemical) and on the duration of the exposure.

In addition, the destruction of cell membranes causes cells to lose potassium and absorb water and sodium from the intercellular matrix. And the increased permeability of the walls of the vessels leads to an increase in the amount of intercellular fluid, which gives a significant edema with a burn of grade 2.

Immediately around the necrosis there is an ischemia zone, in which the blood flow decreases sharply because of the damage to the capillaries, 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 that develops when T cells, leukotrienes, neutrophils, platelets, monocytes, etc. Become activated.

[8], [9], [10]

Symptoms 2nd degree burn

Symptoms of a burn of 2nd degree are a pain, reddening, puffiness, strong soreness of a skin to the touch, and also blisters. At the same time, the very first signs are manifested by burning pain and erythema of the burned area.

The main distinguishing feature of the 2nd degree burn is the detachment of the upper layer of the epidermis and the rapid formation under it of one or more blisters filled with a transparent yellowish exudate. A couple of days after receiving the injury, the liquid in the cavity of the blisters becomes turbid: an insoluble denatured protein and dead leukocytes are mixed with it. Blisters can leak and spontaneously open, and then an eroded bright pink or red burn area appears that looks wet and shiny.

According to experts, when the area of the burn is significant, then due to a violation of the thermoregulatory function of the skin, the temperature for burns of 2 degrees may rise, and patients have fever.

When infected, the color of the burned area changes to purple, the surrounding skin is hot to the touch and swollen, a greenish sap from pus may ooze.

Sun burns of the 2nd degree are manifested by clear skin flushing and her contact soreness, and the bubbles and swelling of the nearby areas appear later. In many cases, with such a degree of skin damage, sun rays show a deterioration in well-being 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 extracellular matrix glycoprotein synthesized by epithelial cells. Without it, phagocytes can not bind to cells of pathogenic bacteria, so that they can be destroyed by phagocytosis. That is why in burn patients the tissue immunity is sharply weakened.

Doctors-kombustiologists argue that the most common complications of burns are associated with microbial invasion of the burn wound, and its result is an infected 2nd degree burn, at which subcutaneous phlegmon and streptococcal or staphylococcal pyoderma can develop.

Scars and scars of 2 degree burns can be an aggravating consequence of burns of extremities (especially the hands and feet), as scar tissue - due to the formation of joint and tendon contractures - can limit their mobility. And scars after burns on the face lead to significant cosmetic defects.

If the burn area is large enough (up to 20-25%), the consequences that are dangerous for the life of the affected person are due to dehydration: the body loses fluid, which is indicated by such signs as thirst, dizziness (especially when changing the position of the body), dry skin and decreased diuresis.

How do 2 degree burns heal?

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

In this case, the stages of healing of the 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. Epithelization is completed by the formation of a new stratum corneum of the epidermis. In this variant, the scar does not remain, and after a while the patch of skin with altered pigmentation at the burn site assumes a practically normal appearance.

Otherwise, an infected 2nd degree burn burns, accompanied by purulent necrosis and inflammation. On the site of necrosis, after cleansing the wound from the dead tissue, a scab is formed, under which the granulation tissue forms: within two to three weeks it fills the skin defect. The granulation tissue is fibrous in structure; then it is transformed into a mature connective tissue consisting of fibers of collagen fibrillar protein. Therefore, when infection of burned skin surfaces, scars and scars of burns of 2 degrees are formed.

[11], [12], [13], [14]

Diagnostics 2nd degree burn

Diagnosis of a burn of the 2nd degree is carried out by visually inspecting the site of the injury and clarifying its location and origin.

As a result, the doctor must determine the degree of burn (ie, 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 swelling of the tissues and signs of infection are estimated. The combination of these clinical factors will determine the tactics of treatment and the prevention of possible complications.

With a significant surface of the 2nd degree burn, blood tests (complete clinical) and a detailed urinalysis for an objective evaluation of the overall homeostasis are taken.

Instrumental diagnostics with the help of an ophthalmoscope is used for eye burns, and an x-ray is needed when the esophagus is burned.

Differential diagnosis

The task that differential diagnostics performs is to distinguish between the 2 degree burn and the 3A burn, which also causes bubbles.

Treatment 2nd degree burn

In adults and children older than five years, treatment of a 2nd degree burn with an area> 15%, and also occupying more than 5% of the skin of a 2-degree burn in a child under five years old and an adult over 60 is performed in a medical institution. Any type 2 burns in areas such as arms, legs, face (especially the eyes), groin, also require hospitalization. In the hospital, an anti-tetanus prick is made and anesthesia is performed.

First aid for burns of 2nd degree

Follow the sequence of actions that include first aid for burns of the 2nd degree:

•  without delay, the effect of the damaging agent or contact with the source of thermal and any other burn is terminated and an ambulance is called;
• cooling the burned area with cold water (+ 16-17 ° C) - for a quarter of an hour (it is impossible to use ice and water below + 10 ° C);
• if the chemical burns, in the same way (a large volume of running water t + 12-15 ° C) liquid chemical substance is washed off (sulfuric acid is first dried with a dry cloth); the powdered chemical is first removed by a dry process. More information in the article - What to do with a chemical burn
• any painkiller in tablets is taken;
• a dry sterile dressing is applied to the burn surface, a large lesion area is closed with sterile gauze napkins;
• if the victim does not vomit, he is given water with the addition of table salt (half a teaspoon of 0.5 liters).

Treatment begins with cleaning the burnt surface with water and treating with antiseptics: 2-3% solution of hydrogen peroxide or furatsilina, chlorhexidine solution or miramistine. A intact skin around the perimeter of the burn is disinfected with alcohol-containing products.

Small bubbles, formed with a burn of grade 2, do not open, but large - a doctor should open the sterile instrument. After the exudate exits to the damaged area (covered with exfoliated epithelium), medicines are applied and a dressing is applied. Removal of exfoliated skin, which served as the outer wall of a burn blister, is also performed by a surgeon - provided that the exudate becomes cloudy. Any independent manipulations with burn blisters are categorically contraindicated because of the high risk of development of the suppuration.

Treatment of a 2nd degree burn after opening the bladder involves the use of antimicrobial agents and agents that help repair the skin.

Antibiotics for burns of 2 degrees of minor size are appointed locally - applying directly to the wound surface or to the bandage.

It should immediately be emphasized that in modern kombustiologii ointments are used from burns of 2 degrees not with a vaseline base, but on the basis of high molecular weight hydrophilic homopolymers (PEO).

As an effective tool have proven themselves:

• Antibacterial anti-inflammatory ointment Levomekol with burns of 2 degrees, containing chloramphenicol (levomycetin) and regenerating agent methyluracil; the drug is applied to the burned area or impose a bandage soaked in it (once a day).
• Combined ointment Levosin (with levomitsetin, sulfadimetoksinom, methyluracil and anesthetic trimecaine).
• Antimicrobial ointment with sulfadiazine silver (Sulfadiazine, Sulfagin, Dermazin, Argosulfan). The drug is not used in cases of significant exudation and problems with kidney and liver, children under three months and pregnant. Possible side effects in the form of allergies, a decrease in the level of leukocytes, inflammation of the kidneys and tissue necrosis.
• Ointment with streptocid and nitazole Streptonitol and 0.1% gentamicin ointment (used with infected burns once or twice a day).

The list, which includes external medicines to improve trophism of tissues and stimulate skin regeneration, is headed by Panthenol ointment for second-degree burns - based on provitamin B5 dexpanthenol. This product is also available in the form of a Panthenol anti-burn spray. More information - Ointment for burns

Eye burn of 2nd degree ophthalmologists are treated in a comprehensive manner, including with the help of such eye drops as Okomistin (Ofamyrin) and Tiotriazolin.

[15],

Care for a burn of 2nd degree

The main thing that requires care for a burn of 2nd degree is to comply with the rules of antiseptic to minimize the attachment of a secondary infection.

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

Optimal is the replacement of the dressing (with the treatment of damage by antiseptics and the imposition of the next dose of ointment) after it has become wet. The special antibacterial absorbent dressings for burns of 2 degrees (and 3 degrees) - Mepilex Ag, Atrauman Ag, Silkofix, Fibrotul Ag, Fibrosorb, Aquacel Ag Burn Hydrofiber (including in the form of gloves - help to reduce the risk of infection). It is more effective to treat a burn of a hand or palm).

At each change of any bandage, the wound must be inspected and its condition assessed, since the purulent inflammation that has arisen does not exclude the need for surgical treatment.

[16], [17]

Operative treatment

To avoid large-scale suppuration and the ingestion of necrosis products of dead tissues into the systemic blood stream, and also to restore the skin after the 2nd degree burn, it was physiological as much as possible, surgical sanitation of the burn surface-necrectomy.

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

If necessary, simultaneously close the wound with dermo-epidermal autografts, and xenografts are used to stimulate the processes of epithelialization and repair of the skin.

Homeopathy, physiotherapy, vitamin therapy

When appointing homotoxic drugs, the constitutional type and character of a person are taken into account; In occasion of burns very few people address to homeopathists. Homeopathy for the treatment of burns of the 2nd degree recommends such means as Arnica 30 (arnica mountainous), Aconit 30 (aconite), Cantharis 30 (extract from the flank fly, taken inside every hour until the pain disappears), Sulphuricum acidum 30 (sulfuric acid) and Urtica urens (nettle extract burning).

Also, anti-inflammatory and anesthetic homeopathic ointment Traumeel C can be used for second-degree burns, which is applied to the healing wound under the bandage (but it can cause skin flushing and itching).

Doctors use physiotherapeutic treatment in case of extensive burns. The main methods include magnetotherapy, EHF-therapy, local hyperoxygenation and barotherapy. With post-burn cicatrices, thalassotherapy is used, with contractures - massage and exercise therapy.

It is recommended to take additional vitamins A, C and E. The first two contribute to the production of collagen; Vitamin C reduces the need for tissues in the fluid and helps to remove puffiness; Vitamin E (400-800 IU per day) promotes healing.

Treatment of burns of 2 degrees at home

Treatment of burns of 2 degrees at home is possible only with small lesions. So, if the scalded finger is treated at home, then the hand burn is outpatient, and the entire hand burns in the hospital.

The medicines and principles of caring for the burn wound are the same. However, some recommend alternative treatment with cabbage leaves, pumpkin, potato (with sour cream) or carrot compresses. Also, I advise you to smear the burn with raw egg white or sprinkle powder from the egg shell ...

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

Minor burns can be treated with compresses with decoctions of marigold, plantain, St. John's wort, kipreya (willow-tea), snake mountaineer, twig, lingon leaves (tablespoon per glass of water). However, the open wound herbal compresses do not. You can apply boiled water boiled dry kelp (sea cabbage) with sunburn.

Burned surface several times a day, sprinkle with juice of leaves of aloe, calanchoe, golden mustache or solutions of mummies and propolis.

Nutrition for burns of 2 degrees

The key rules on which nutrition is based on burns: a sufficient amount 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 - due to protein losses through the burn wound - the need for proteins increases. According to experts, dieticians, you need to eat 1.5-2 grams of protein per kilogram of body weight every day, that is at least 25% of the daily calories. High protein foods include meat, poultry, fish, nuts, seeds, dairy products and eggs.

The diet should have enough carbohydrates: first, 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 nutrition for burns, to provide the body with the necessary fatty acids. But fat should not be more than 30% of the daily number of calories, as their excess can weaken the immune system.

Prevention

Is it possible to prevent burn injuries? Theoretically possible - with strict observance of all the rules of safety at work and at home. But in practice, often my mother is working in the kitchen near the burning plate, and next to it is a small child. Or containers with dangerous substances stand where they can be taken by the same child and open the lid - just so, out of curiosity ...

[18], [19], [20]

Forecast

Of course, if you defeat more than 10% of the skin after you go to a medical facility, you will receive not only adequate treatment, but also a hospital one with a burn of grade 2.

But keep in mind that the forecast for burns is considered favorable only at 30% of skin lesions, up to 60% - conditional-favorable, and everything that is higher (and in children - above 40-45%) is problematic and unsuccessful.