Burns are injuries of the skin involving the epidermis and dermis to varying degrees. 86% of burn
injuries are thermal, 4% electrical, and 3% chemical, with the other 7% attributable to varying
miscellaneous sources such as radiation injury (Schaefer & Szymanski, 2020). Most burns are small
and superficial, requiring little intervention. extensive burns, however, require treatment as major
trauma and can evoke systemic response.
Violation of the integumentary layer removes the body's first line of defence against infection,
which is the primary way in which burns can have significant consequences for overall health. In the
case of severe burns, the role of the skin in retaining fluid is also compromised and patients can
suffer significant electrolyte imbalances because of incredibly large and rapid shifts of fluids
(Schaefer & Szymanski, 2020). c
Burns are classified first by the cause or type of burn: Thermal, electrical, chemical (further divided
into acid or alkali burns), radiation, friction, or cold exposure (Schaefer & Szymanski, 2020). Extent
of the burn is determined by percentage of total body surface area involved [TBSA]. Burns are then
classified by depth: first degree or superficial involves only the epidermis, second degree or partial
thickness burns involve both the epidermis and dermis, and third degree or full thickness burns
violate all layers of the skin and extend into subcutaneous tissues (Schaefer & Szymanski, 2020).
Superficial burns are characterized by a warm, dry, red, painful, soft, and blanching area which is
rarely blistered in appearance. Partial thickness burns are similarly painful, red, soft, and blanching,
but are often blistered and moist in appearance. Full thickness burns are characterized by little to
no pain; a white, brown, or charred appearance; a firm and leathery texture to palpation; and no
blanching with palpation.
Diagnosis of burns and their extent is primarily visual, although in extensive burns labs such as CBC
and chemistry panel are warranted. Similarly, if inhalation injury is suspected a carboxyhaemoglobin
level should be obtained.
Otherwise, percent TBSA is determined by the Rule of Nines, the Lund & Browder chart (more
accurate, especially in paediatrics), and the Palmar Surface Rule for small burns (Schaefer &
Szymanski, 2020). When calculating percent TBSA, only partial and full thickness burns are
considered and superficial burns are excluded.
Concept and Etiology:
Atopic dermatitis, also referred to as eczema, is a chronic inflammatory condition. It is a condition
that makes your skin red and itchy. It is common in children but can occur at any age. “Atopic
dermatitis is long lasting and tends to flare periodically. It has an inherited tendency and may be
accompanied by asthma and allergic rhinitis. It tends to be characterized by remissions and
exacerbations. The exact cause is unknown, but atopic dermatitis may result from an immune
system malfunction, like hypersensitivity” (Story, L., 2017).
Classification:
Atopic dermatitis is seen in approximately 10% to 30% of children and 2% to 10% of adults in
developed countries. Atopic dermatitis is divided into three subsets based on the age of onset:
Early-onset atopic dermatitis (birth to 2 years old): c most common type of atopic dermatitis, with
approximately 60% of cases starting by age 1. Sixty percent of cases resolve by 12 years old.
Late-onset atopic dermatitis: c symptoms begin after the onset of puberty
Senile onset atopic dermatitis: an unusual subset with onset in patients older than 60 years old.
(Stat Pearls, 2021)
Clinical Manifestations:
The skin lesions primarily affect the face, scalp, hands, or feet in young children. “Clinical
manifestations may be made worse by exposure to allergens, cold and dry air, upper respiratory
infections, contact with irritants, dry skin, emotional stress, and extreme temperatures”. Signs and
symptoms are listed below:
Red to brownish-Gray coloured skin patches
Pruritus, which may be severe, especially at night
Vesicles
Thickened, cracked, or scaly skin
Irritated, sensitive skin from scratching (Mayo Clinic, 2020)
Diagnostic Tests:
Diagnostic procedures for atopic dermatitis include a:
history
physical examination
allergy testing
skin biopsy
REFERENCES
Story, L. (2017). Pathophysiology: A Practical Approach (3rd Edition). Jones & Bartlett Learning.
https://mbsdirect.vitalsource.com/books/9781284142983
Kolb L, Ferrer-Bruker SJ. Atopic Dermatitis. [Updated 2021 Aug 13]. In: Stat Pearls [Internet].
Treasure Island (FL): Stat Pearls Publishing; 2021 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK448071/
Atopic dermatitis (eczema) - Symptoms and causes - Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/symptoms-causes/syc-
20353273
Schaefer, T. J., & Szymanski, K. D. (2020). Burn Evaluation and Management. PubMed; Stat Pearls
Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430741/
