Burns can be categorized by their depth of penetration into the skin.
Superficial burns, previously known as first degree burns, are similar to sunburns and heal in a few days without any sequelae.
Partial thickness burns, previously known as second degree burns, will typically involve the epidermal skin layer while only partially damaging the dermal layer. The implications are that the burn injury can heal spontaneously over several days to weeks by re-epithelialization from some of the hair follicles and glands within the dermis and will do so with no scar or minimal scarring. This type of burn is also very painful as the nerve endings in the skin are exposed, leading to pain severe enough to require narcotics, both generally, and also for dressing changes.
In a typical hot liquid (i.e., scald) burn, the temperature of the liquid and the duration of skin contact of the liquid are the factors that determine the degree of damage. Standard hot coffee and tea is served at approximately 140 degrees F (+/-10 degrees). Liquid at 140 degrees would take approximately 5 seconds to cause a deep burn. Scald burns are usually deep partial thickness as evidenced by the spontaneous healing with basic burn dressings and local care.
Full thickness burns, previously called third degree burns, involve both the epidermis and the dermis and will not heal spontaneously without severe scarring and most often are treated by surgical excision and skin grafting. This type of treatment will lead to serious scarring of the burned areas as well as the areas where the skin grafts are taken. These types of burns also are less painful as the nerves in the skin are permanently damaged.
Typical explosion or flame injury burns are full thickness in nature, which means that surgical intervention and skin grafting is required. The usual sequelae of a full thickness burn injury is severe scarring with possible contracture of the skin which can limit movement of the areas that are scarred. Such scars can be painful and stiff and may limit the patient’s ability to move normally, work, and return to the normal life that existed pre-injury.
Pigment changes from burns
One other effect of a burn injury can be a change in the color or pigment of the skin. This is due to damage to the pigment producing cells, known as melanocytes, within the dermis layer. This development can be permanent. It is characterized by a lightening of the skin color (i.e., hypopigmentation) which, again, comes from damage to the melanocytes. Once these pigmentary changes have been present for more than 18 months, they can be considered permanent. Because of hypopigmentation, a patient will need to be advised to wear sunblock when in the sun.
Burn medical expert witness specialties include burn scar, burn medicine/ surgery, plastic surgery, emergency medicine, urgent care medicine, pediatrics, pediatric emergency medicine, and child abuse and neglect.