The skin has an important role to play in the fluid and temperature regulation of the body.

If enough skin
area is injured, the ability to maintain that control can be lost. The skin also acts as a protective barrier
against the bacteria and viruses that inhabit the world outside the body.

A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction.

The amount of damage that a burn can cause depends upon its location, its depth, and how much body
surface area that it involves.

Cause
Electrical
Electrical burns are caused by either an electric shock or an uncontrolled short circuit. (A burn from a hot,
electrified heating element is not considered an electrical burn.) Common occurrences of electrical burns
include workplace injuries, or being defibrillated or cardioverted without a conductive gel. Lightning is also
a rare cause of electrical burns.

Classification
Burns can be classified by mechanism of injury, depth, extent and associated injuries and comorbidities.

By depth
Currently, burns are described according to the depth of injury to the dermis and are loosely classified into
first, second, third and fourth degrees.

VIDEO!

Time to
Nomenclature Layer involved Appearance Texture Sensation Complications Example
healing

Redness 1wk or
First degree Epidermis Dry Painful None
(erythema) less

Second degree Red with

Extends into
(superficial clearblister. Local
superficial Moist Painful 2-3wks
partial Blanches with infection/cellulitis
(papillary) dermis
thickness) pressure

Red-and- Weeks -
Scarring,
Second degree white with may
Extends into deep contractures (may
(deep partial bloody Moist Painful progress
(reticular) dermis require excision
thickness) blisters. Less to third
andskin grafting)
blanching. degree

Scarring,
Third degree Extends through Stiff and Dry, Requires
Painless contractures,
(full thickness) entire dermis white/brown leathery excision
amputation
Extends through
Amputation,
skin,subcutaneous Black;
Requires significant
Fourth degree tissue and into charred Dry Painless
excision functional
underlying muscle witheschar
impairment
and bone
By severity
Major

Major burns are defined as:

 Age 10-50yrs: Partial thickness burns >25% TBSA

 Age <10 or >50: Partial thickness burns >20% TBSA
 Full thickness burns >10%
 Burns involving the hands, face, feet or perineum
 Burns that cross major joints
 Circumferential burns to any extremity
 Any burn associated with inhalational injury
 Electrical burns
 Burns associated with fractures or other trauma
 Burns in infants and the elderly
 Burns in persons at high-risk of developing complications

These burns typically require referral to a specialised burn treatment center.

Moderate

Moderate burns are defined as:

 Age 10-50yrs: Partial thickness burns involving 15-25% TBSA

 Age <10 or >50: Partial thickness burns involving 10-20% TBSA
 Full thickness burns involving 2-10% TBSA

Persons suffering these burns often need to be hospitalised for burn care.
Minor

Minor burns are:

 Age 10-50yrs: Partial-thickness burns <15% TBSA

 Age <10 or >50: Partial thickness burns involving <10% TBSA
 Full thickness burns <2% TBSA without associated injuries.

These burns usually do not require hospitalisation.

By surface area
Burns can also be assessed in terms of total body surface area (TBSA), which is the percentage affected
by partial thickness or full thickness burns.
The rule of nines is used as a quick and useful way to estimate the affected TBSA.