foreign is the damage that happens after something really hot like a fire hot water or steam or even a hot object comes into contact with skin but burn injuries can also be caused by extreme cold electricity some chemicals like strong acids or radiation like from the Sun or Medical Treatments ultimately Burns cause damage and inflammation of the skin the skin plays an important role in protecting underlying muscles bones ligaments and internal organs forming a barrier to infectious pathogens and preventing water loss from the body now the skin is divided into three layers the epidermis dermis and hypodermis the epidermis forms the thin outermost layer of skin and it's made up of several layers of keratinocytes which make and secrete glycolipids which help to prevent water from easily seeping into and out of the body underneath the epidermis is the thicker dermis layer that contains the nerves and blood vessels but the dermis is divided into two layers a thin papillary layer just below the epidermis and a deeper reticular layer the papillary layer contains fibroblasts which produce a connective tissue protein called collagen the fibroblasts are arranged in finger-like projections called papillae Each of which contains blood vessels and nerve endings nerve endings found in this layer sense pain and fine touch which allows you to feel something like a feather touching your arm the reticular layer of the dermis is even thicker than the papillary layer the collagen in the reticular layer is packed very tightly together making it excellent tissue support in addition fibroblasts in the reticular layers secrete elastin which is a stretchy protein that gives skin its flexibility the reticular layer also contains the Skin's accessory structures like oil and sweat glands hair follicles lymphatic vessels and nerves and all of the blood vessels that serve these tissues a type of nerve ending found here detects pressure or vibration which allows you to feel someone grabbing your arm finally just below the reticular layer is the hypodermis it's made of fat and connective tissue that insulates and pads the deeper tissue and anchors the skin to the underlying muscle when the skin is burned it damages cells and the proteins within them and the number of skin layers affected determines the burn degree so in first degree burns also called superficial burns the burn only affects the epidermis in second degree burns the burn affects the epidermis and the dermis if only the papillary layer is burned it's considered a second degree superficial partial thickness burn but if the burn reaches the deeper reticular layer but doesn't extend through the entire layer then it's considered a second degree deep partial thickness burn in third degree burns also called full thickness burns the entire epidermis and dermis are affected and finally fourth degree burns extend into the hypodermis when a skin layer is affected it means that the skin can't function effectively and common complications are infections especially from pseudomonas eruginosa and water loss through the damaged skin as Burns heal macrophages move into the tissue to remove dead cells and fibroblasts create new collagen to heal the damaged skin the more extensive the area with new collagen the more extensive the scar so scars are common in second-degree deep partial thickness Burns and third and fourth degree burns symptoms of a burn depend on the degree of the burn in first degree the affected area becomes red dry and painful these areas also tend to blanch turning white as blood flow is restricted with compression second-degree superficial partial thickness Burns can be read with clear blisters wet as if they're weeping and are even more painful than first-degree Burns but still blanch a second degree deep partial thickness burn may vary in color from yellow or white to Red have blisters and can be wet or dry because of damage to blood vessels and nerve endings Burns of this degree may not blanch and there may only be pain due to pressure because of nerve damage a third degree burn can appear waxy white to leathery gray or black and dry again blanching doesn't occur and the pain may only feel like deep pressure in other words they can be relatively painless Additionally the elastin damage causes the burn to be stiff or inelastic finally fourth degree burns are charred black dry have pain only from deep pressure but can be painless from complete destruction of nerve endings and have patches of dead skin having said that the margins of all Burns often have lots of damaged nerve endings and that can be painful the diagnosis of a burn is often based on the Burn's appearance and the amount or type of pain but sometimes tissue biopsies are obtained to accurately determine which layers are affected in adults the severity of burns is calculated using the rule of nines the rule of nines evaluates several distinct sections of the body's total surface area for the presence and degree of burns 11 of the sections each make up nine percent of the body's surface area and are the head right arm left arm chest abdomen upper back lower back the front of the left leg and the back of the left leg and the same for the right leg a final section the groin accounts for the missing one percent of the body's surface area the treatment for a burn is determined by what caused the burn the rule of nines and the location of the Burns in the body in general immediate treatment typically includes preventing further burning like flushing the burn with cool but not ice cold running water after that it's important to manage pain with medication minor burns like first and second degree superficial thickness Burns can heal on their own over a few days or weeks by keeping them bandaged and clean with soap and water sometimes lotions to prevent drying or topical antibiotics can be used if blisters form it's best to leave them alone because the intact skin helps to prevent infections for more serious burns like electrical and chemical burns or second or third degree burns in sensitive areas like the face hands and genitalia hospitalization in specialized burn centers is often needed in those situations it's important to replenish lost fluids and electrolytes and to prevent infections with antibiotics surgical procedures like skin grafting excision of dead skin or amputation especially in third or fourth degree burns may also be needed so to recap a burn is injury protein denaturation and cellular damage that occurs in the skin caused by extreme heat or cold electricity some chemicals or radiation the degree of burn is determined by whether the epidermis dermis or hypodermis are affected and each degree has specific symptoms the rule of nines the cause of the burn and location of the burn can help determine treatments in general treatments include minimizing the initial burn and Pain Management minor burns don't typically require treatment Beyond keeping the area clean moist and bandaged but severe burns may require more extensive medical intervention particularly hospitalization at Specialized burn centers to prevent infections and dehydration