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Whar are burns?
Technically burns can be divided into, chemical burns, thermal burns, electrical burns, laser burns and microwave burns. Furthermore, burns could be of domestic, industrial or environmental origin. From the point of view of the readers, I would restrict my discussion to the category of minor thermal burns of domestic origin that include burns as a result of direct contact with fire, hot iron or hot liquids. Every effort would be made to keep the discussion as non-technical as possible, stressing the first aid measures so as to benefit the general reader.

Types of burns:
Thermal (heat) injury inflicts damage to different layers of the skin, with or without damage to the underlying tissue, depending upon the depth or severity of the injury. Burns is generally divided into superficial and deep burns, which is a useful division from the point of view of outcome.

How to recognize the depth of burns?
As is evident from the name, superficial burns injure superficial layers of the skin, whereas, deep burns damage deeper layers including the underlying tissues such as nerves, blood vessels and sometimes even the muscles. The extent of burns in terms of the surface area of the skin damaged is also an important determinant. Generally greater the surface area, greater is the risk of complications, including threat to life. Minor superficial burns are least likely to lead to complications or any disability. It is usually easy to figure out the depth of burns. Superficial burns are characterized by redness of the skin along with intense pain followed in a while by formation of blisters. Deeper burns, on the other hand may leave behind a black or brown leathery skin. Paradoxical as it may seem, deep burns may not be very painful because of damage to the underlying nerves, which are required to carry pain sensations to the brain.

Immediate measures:
It would be logical to neutralize heat immediately with cold for two reasons: a) cooling soothes the skin, thus reducing pain and discomfort.  b) immediate cooling also prevents/arrests the ongoing thermal damage, thus limiting the final extent of tissue damage. Immersing the burnt part in cold water or cooling with ice or even a cold object from a refrigerator are some measures worth mentioning. Any item of clothing on fire should immediately be removed from the body.

What should not be done?:
Generally people resort to all sorts of domestic remedies, and the list is endless. Such measures frequently do more harm than good. Coloured poultices may cause permanent tattooing of the skin besides masking the skin damage. Certain antiseptics like Dettol or Furacin cream, which are common household items are known to cause skin allergies and therefore, should be avoided at best. Topical creams containing steroids e.g., Betnovate should also be avoided. Applying tooth paste, believing that it produces cooling is a misconception.

Whom to consult?:
In an emergency any doctor should be able to offer help, but if situation permits, a dermatologist (skin specialist) should be consulted for minor burns. For more extensive burns, a general surgeon or a plastic surgeon (if available) would be an appropriate choice.

Minor superficial burns may cause temporary changes in skin colour, but ultimately heal without any residual scarring. Relatively deeper burns may lead to scaring and something called “keloid” formation, which is excessive accumulation of collagen in the skin. It appears (after months) as a hard, protuberant mass over the burn scar and may be painful, or restrict movements of the underlying joint. Treatment is available to some extent. Old burn scars are known to develop skin cancers and therefore, medical help should be sought at the slightest suspicion of any change appearing in an old burn scar.



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