Burns: Symptoms, Types, Causes and Treatment

Burn injuries are among the most common and challenging forms of trauma, affecting millions worldwide each year. They range from minor scalds to life-threatening injuries that require complex multidisciplinary care. Understanding the symptoms, types, causes, and modern treatment strategies is crucial for both patients and healthcare professionals. This comprehensive guide delves into the latest research and clinical insights to help you navigate the complex world of burns.

Symptoms of Burns

Recognizing the symptoms of burns early can be lifesaving and is the first step toward effective treatment. Burn injuries don't just affect the skin—they can trigger a cascade of local and systemic reactions, leading to a wide variety of symptoms.

Symptom	Description	Severity/Progression	Source
Pain	Ranges from mild to severe	Acute and may become chronic	1 2
Redness	Inflammation and increased blood flow	Typically in superficial burns	5 6
Blistering	Fluid-filled lesions	Indicates partial-thickness burns	5 6
Swelling	Tissue edema	Can escalate with burn depth	3 6
Peeling	Skin detachment	Severe or deep burns	5
Pruritus	Itching, often persistent	Chronic, post-healing	2
Fatigue	Generalized tiredness	Common after severe burns	2
Infection	Wound or systemic signs	Major risk in deeper burns	10
Anxiety/Depression	Psychological distress	Often chronic in survivors	1 2
Impaired mobility	Reduced movement	If joints or large areas involved	2

Table 1: Key Symptoms of Burns

Understanding Burn Symptoms

Burn symptoms vary depending on the depth, size, and location of the injury, as well as individual patient factors.

Acute Local Symptoms

• Pain and Redness: The most immediate and noticeable symptoms. Superficial burns are generally more painful due to exposed nerve endings, while deeper burns may initially be less painful if nerves are destroyed 3 5.
• Blistering and Swelling: Partial-thickness (second-degree) burns often present with blistering and noticeable swelling due to fluid accumulation 5 6.
• Peeling and Skin Loss: Full-thickness (third-degree) burns may cause the skin to appear white, leathery, or charred, eventually leading to peeling or sloughing 5.

Systemic and Chronic Symptoms

• Pruritus (Itching): Persistent itching is common during healing and may become chronic in survivors 2.
• Fatigue and Weakness: Large burns can provoke systemic inflammatory responses, leading to fatigue, weakness, and impaired motor strength 2.
• Infection: Burn wounds are highly susceptible to bacterial and fungal infections, which significantly increase morbidity and mortality 10.
• Psychological Impact: Survivors frequently experience anxiety, depression, and even post-traumatic stress, often requiring long-term psychological support 1 2.
• Impaired Mobility: Burns over joints or extensive areas can limit range of motion, especially if scarring or contractures develop 2.

The Interplay of Symptoms

It's important to recognize that these symptoms are often interrelated. For instance, chronic pain can exacerbate psychological symptoms, and vice versa. Early multidisciplinary intervention is key to preventing a downward spiral of physical and mental health 1 2.

Types of Burns

Burns are not a one-size-fits-all injury. They can be classified by depth, cause, and extent, each impacting how they are managed and how they heal.

Type	Depth/Layer Involved	Key Characteristics	Source
Superficial	Epidermis only	Red, painful, dry, no blisters	3 5 6
Partial-thickness	Epidermis + part dermis	Blisters, moist, very painful	3 5 6
Full-thickness	All skin layers	White or charred, leathery, painless	3 5 6
Thermal	Varies	Caused by heat sources	4 5 9
Chemical	Varies	Exposure to acids/alkalis	4 5 7
Electrical	Varies, deep possible	Entry/exit wounds, tissue damage	7 9
Radiation	Superficial to deep	Sunburn, radiotherapy burns	4
Friction	Superficial or deeper	Skin abrasion + heat injury	4

Table 2: Main Types of Burns

Classification by Depth

• Superficial (First-degree) Burns: Affect only the outermost layer (epidermis). Appear red, dry, and painful but generally heal without scarring 3 5 6.
• Partial-thickness (Second-degree) Burns: Involve the epidermis and part of the dermis. Characterized by blisters, intense pain, and a moist appearance. These can convert to deeper burns if not managed properly 3 5 6.
• Full-thickness (Third-degree) Burns: Destroy the entire dermis and sometimes underlying tissues. The area may look white, waxy, or charred, and sensation is diminished due to nerve destruction 3 5 6.

Classification by Cause

Burns can also be classified based on their etiology:

• Thermal Burns: Result from contact with hot surfaces, flames, or scalding liquids. Most common in both adults and children 4 5 9.
• Chemical Burns: Caused by acids, alkalis, or other corrosive substances. Household cleaning agents are a frequent culprit, especially in children 5 7.
• Electrical Burns: These injuries can be deceptive, causing deep tissue damage beyond the visible skin injury. Entry and exit wounds may be present 7 9.
• Radiation Burns: Typically result from prolonged sun exposure (sunburn) or medical treatments such as radiotherapy 4.
• Friction Burns: Occur when skin is abraded and heated by contact with rough surfaces (e.g., road rash) 4.

The Three Zones of Injury

Jackson's model describes three zones in a burn wound:

• Zone of Coagulation: Central area of irreversible tissue necrosis.
• Zone of Stasis: Surrounding area with reduced perfusion, potentially salvageable with prompt care.
• Zone of Hyperemia: Outer area with increased blood flow, likely to recover unless further insult occurs 3 6.

Special Considerations

• Pediatric Burns: Children, especially those under six, are at higher risk for scalds and often sustain larger body surface area burns relative to their size 5 9.
• Vitamin D Deficiency and Healing: Burn patients, especially with electrical and flame burns, often have vitamin D deficiency, which can delay healing 7.

Causes of Burns

Burns have a wide range of causes, from everyday accidents to rare industrial exposures. Understanding the underlying cause is essential, as it dictates both immediate management and long-term outcomes.

Cause	Typical Scenario	High-Risk Group	Source
Scald	Hot liquids/steam	Young children	5 9 10
Flame	Fire, explosions	Adults, older children	5 9
Contact	Hot surfaces/objects	Children	5 9
Chemical	Acids, alkalis, detergents	Children (household), adults	5 7
Electrical	Faulty appliances, wiring	Adults, workers	7 9
Radiation	Sun, medical treatment	All ages	4
Friction	Road accidents, sports	Active individuals	4

Table 3: Main Causes of Burns

Thermal Causes

• Scalds: The leading cause of burns in children, typically from hot water, beverages, or bathing accidents.
• Flame Burns: Common in adults, often related to house fires, explosions, or accidents with open flames 9.
• Contact Burns: Result from touching hot objects like stoves, irons, or heaters, frequently in children 5 9.

Chemical Burns

• Household Products: Cleaners, bleaches, and detergents are the most common causes in children. Severity depends on the chemical's concentration and duration of contact 5.
• Industrial Exposures: In adults, workplace accidents involving strong acids or alkalis can cause severe burns 7.

Electrical Burns

• Low-Voltage Injuries: May appear minor on the surface but cause deep tissue and organ damage.
• High-Voltage Injuries: Often result in extensive tissue destruction, sometimes leading to amputation 7 9.

Radiation and Friction

• Sunburn: The most familiar type of radiation burn, caused by UV exposure.
• Radiotherapy: Medical treatment can sometimes injure the skin.
• Friction: Occurs in road traffic accidents or sports injuries, combining abrasion with thermal injury 4.

Epidemiological Insights

• Age and Gender: Young children and males are at higher risk for burn injuries 9.
• Seasonality: Incidence peaks in autumn, possibly due to heating-related accidents 9.

Treatment of Burns

Burn treatment has evolved significantly, aiming not just for survival but for optimal recovery and quality of life. Management is tailored to burn severity, location, cause, and patient-specific factors.

Treatment	Main Goal	Suitability/Indication	Source
Fluid resuscitation	Restore perfusion, prevent shock	Moderate to severe burns	3 13 14
Wound cleaning & debridement	Prevent infection, remove dead tissue	All burns	12 13 14
Dressings	Protect, promote healing	Partial- and full-thickness	12 15
Antibiotics	Prevent/treat infection	Infected or large burns	10 13
Skin grafting	Replace lost tissue	Full-thickness/large burns	12 13 14
Pain management	Alleviate suffering	All burns	1 2 13
Nutrition support	Enhance healing, reduce catabolism	Severe burns	13 14
Rehabilitation	Restore function/mobility	Deep/large burns	1 7 13
Scar management	Minimize contractures/scarring	During/after healing	16
Psychological support	Address mental health	All burn survivors	1 2 13

Table 4: Key Burn Treatments

Initial and Emergency Management

• Assessment: Accurately estimate burn size (Total Body Surface Area, TBSA) and depth. Identify and manage life-threatening issues (airway, breathing, circulation) 14.
• Fluid Resuscitation: Prompt intravenous fluids are essential for burns >10-20% TBSA to prevent shock and maintain tissue perfusion 3 13 14.
• Pain Control: Effective analgesia is crucial from the outset and throughout recovery, including opioids, non-opioid medications, and sometimes novel interventions like transcranial direct current stimulation (tDCS) for chronic pain 1 2 13.

Wound Care and Infection Control

• Cleansing and Debridement: All burns require cleaning; deeper burns need debridement (removal of dead tissue) to reduce infection risk 12 13 14.
• Dressings: Traditional options like silver sulphadiazine (SSD) have been standard but newer dressings now offer faster healing and greater comfort. Modern dressings may also be easier to manage and less painful to change 15.
• Antibiotics: Used when infection is suspected or confirmed. Common pathogens include Pseudomonas, Acinetobacter, and Staphylococcus. Early, targeted therapy is critical due to high infection risk 10 13.

Surgical Interventions

• Skin Grafting: Required for extensive full-thickness burns or burns not healing with conservative measures. Early excision and grafting improve outcomes and reduce infection 12 13 14.
• Advanced Wound Therapies: Skin substitutes and bioengineered materials are increasingly used to improve healing and reduce scarring 11 12.

Supportive Therapies

• Nutritional Support: Severe burns induce a hypermetabolic state. Early enteral feeding and nutritional optimization, including vitamin D supplementation, are vital for recovery 7 13 14.
• Rehabilitation: Physical therapy should begin early to prevent contractures, maintain mobility, and support functional recovery 1 7 13.

Scar and Psychological Management

• Scar Care: Silicone gels, pressure garments, corticosteroids, and, more recently, laser therapies help minimize scarring and contracture formation 16.
• Psychological Support: Burn survivors are at high risk for chronic pain, anxiety, depression, and social isolation. Multidisciplinary support, including mental health professionals, is essential for long-term recovery 1 2 13.

Innovations and Future Directions

• Anti-oxidant Therapy: Supplementation may reduce systemic complications by counteracting oxidative stress 8.
• Novel Modalities: Research into non-invasive brain stimulation (like tDCS) and pharmacologic agents targeting inflammation and metabolism is ongoing 2 13.

Conclusion

Burns are complex injuries that extend far beyond the initial trauma. Effective management relies on early recognition, accurate classification, understanding the cause, and a patient-centered multidisciplinary approach. Advances in wound care, nutrition, psychological support, and scar management continue to improve outcomes for burn survivors.

Key Takeaways:

• Burn symptoms range from pain, redness, and blisters to long-term psychological impacts and impaired mobility 1 2 3 5 6 10.
• Types of burns are classified by depth (superficial, partial-thickness, full-thickness) and cause (thermal, chemical, electrical, radiation, friction), each with unique features and risks 3 4 5 6 7 9.
• Common causes include scalds, flames, contact with hot objects, chemicals, electricity, radiation, and friction. Children and males are particularly at risk 5 7 9.
• Treatment is multidisciplinary: Initial stabilization, wound care, infection prevention, pain management, nutrition, rehabilitation, scar care, and psychological support are all vital. New therapies and dressings continue to improve outcomes 1 2 7 10 11 12 13 14 15 16.

Burn care is evolving rapidly, but early intervention and holistic, individualized care remain the cornerstones of optimal recovery.