Burns and other common skin conditions
Burns
Causes: Thermal, friction, electrical, chemical, radiation
The presentation of burns is determined by the classification. See below:
Superficial (first-degree burn)
- Layers affected: Epidermis only
- Appearance: Red, dry, no blisters
- Pain level: Mild to moderate
- Healing time: 3-7 days without scarring
- Example: Sunburn
Partial-thickness (second-degree burn)
a. Superficial partial-thickness
- Layers affected: Epidermis + upper dermis
- Appearance: Red, moist, blisters present
- Pain level: Very painful (nerve endings intact)
- Healing time: 10-21 days, minimal to no scarring
b. Deep partial-thickness
- Layers affected: Epidermis + deeper dermis
- Appearance: Mottled red/white, sluggish blanching
- Pain level: Less painful (nerve endings damaged)
- Healing time: 3-6 weeks, scarring likely
Full-thickness (third-degree burn)
- Layers affected: Epidermis + entire dermis (may extend to subcutaneous tissue)
- Appearance: White, leathery, charred, dry
- Pain level: Painless (nerve endings destroyed)
- Healing time: Requires skin grafting, significant scarring
Subdermal (fourth-degree burn)
- Layers affected: Epidermis, dermis, fat, muscle, and bone
- Appearance: Black, charred, necrotic tissue
- Pain level: Painless (complete nerve destruction)
- Healing time: Requires surgical intervention; amputation is possible
Use of grafts for burns
Grafts are required for deep partial thickness and full thickness burns to aid in re-epithelialization. Grafts can be taken from different areas of the body, another individual’s body, or another species. Below are different types of grafts:
- Autografts: taken from the individual
- Allografts: taken from cadavers
- Xenografts: taken from another species (i.e., pig, cow)
Interventions for burns
The specific interventions for burns are determined by the depth of the wound and/or the level of tissue damage. See below for specifics regarding interventions:
First-degree burns
- Cool the burn with cool water.
- Apply over-the-counter pain relievers, such as NSAIDs or acetaminophen.
- Use aloe vera gel or petroleum jelly to soothe the burn.
Second-degree burns
- In addition to the above, apply a topical antibiotic cream, such as Bacitracin or Neomycin.
- Cover the burn with a non-stick dressing.
- Use silver sulfadiazine cream to prevent infection.
Third-degree burns
- Intravenous fluids and pain relievers
- Antibiotic therapy
- Topical dressings, such as mafenide acetate or silver sulfadiazine
- Surgery may be necessary to remove the burned skin and graft new skin.
Other medications
- Corticosteroids may be used to reduce inflammation.
- Antihistamines may be used to relieve itching.
- Sedatives may be used to manage pain and anxiety.
Because corticosteroids can slow wound healing and topical antimicrobials such as silver can be cytotoxic with prolonged use, the PTA should report use of these medications to the supervising PT if wound progress stalls or worsens.
Rule of nines for burn assessment
The rule of nines is a quick method to estimate the total body surface area (TBSA) affected by burns. It differs for adults and children due to variations in body proportions.
Rule of nines for adults
In adults, the body is divided into sections, each representing 9% or a multiple of 9% of the total body surface area:
| Body part | Percentage (%) of TBSA |
| Head & neck | 9% (4.5% front, 4.5% back) |
| Each arm | 9% (4.5% front, 4.5% back) |
| Each leg | 18% (9% front, 9% back) |
| Anterior torso | 18% |
| Posterior torso | 18% |
| Perineum (genital area) | 1% |
Example: A burn covering the entire front of one leg and half the anterior torso would be 9% + 9% = 18% TBSA.
Rule of nines for children
Children have a larger head-to-body ratio, so the Rule of Nines is adjusted:
| Body part | Percentage (%) of TBSA |
| Head & neck | 18% (9% front, 9% back) |
| Each arm | 9% (4.5% front, 4.5% back) |
| Each leg | 14% (7% front, 7% back) |
| Anterior torso | 18% |
| Posterior torso | 18% |
Example: A child with burns covering the entire head and one arm would have 18% + 9% = 27% TBSA.
Other common skin conditions
Impetigo
Impetigo is a bacterial skin infection caused by Staphylococcus aureus or Streptococcus pyogenes. It is highly contagious and commonly affects children. The hallmark feature is honey-colored, crusted lesions that typically appear around the mouth, nose, and hands. Mild itching may be present, but systemic symptoms like fever are rare. Since impetigo is superficial, it does not cause deep tissue damage and is easily treatable with antibiotics.
Cellulitis
Cellulitis is a bacterial skin infection that occurs in the deeper layers of the skin and subcutaneous tissue. It is most commonly caused by Staphylococcus aureus or Streptococcus pyogenes. Unlike impetigo, cellulitis presents with diffuse redness, warmth, swelling, and pain, and it may be accompanied by systemic symptoms such as fever, chills, and malaise. It commonly affects the lower extremities, but can occur anywhere. Cellulitis can spread quickly and requires antibiotics, and in severe cases, hospitalization may be necessary.
Herpes zoster (shingles)
Herpes zoster, or shingles, is a viral infection caused by the reactivation of the varicella-zoster virus (the same virus that causes chickenpox). It presents as a painful, blistering rash that follows a dermatomal pattern - meaning it is limited to one side of the body along a nerve path. Before the rash appears, individuals may experience burning, tingling, or flu-like symptoms. Unlike impetigo and cellulitis, herpes zoster is not a bacterial infection and requires antiviral treatment. A significant complication is post-herpetic neuralgia, which can cause chronic nerve pain even after the rash has resolved.
Dermatitis (eczema)
Dermatitis is a non-infectious inflammatory skin condition caused by an immune response to allergens, irritants, or chronic skin sensitivity. It presents as red, dry, scaly, and itchy skin and is often associated with pruritus (intense itching). Unlike the other conditions, dermatitis is not contagious and does not involve bacterial or viral pathogens. Common triggers include allergens, soaps, stress, and climate changes. Treatment involves moisturizers, corticosteroids, and avoiding triggers.
Psoriasis
Psoriasis is a chronic autoimmune skin condition that causes rapid skin cell turnover, leading to the buildup of thick, scaly plaques on the skin. It is characterized by red, inflamed patches with silvery-white scales, often appearing on the scalp, elbows, knees, and lower back. The condition is not contagious and can be triggered by stress, infections, medications, and environmental factors. Psoriasis is associated with immune system dysfunction, specifically involving T-cells and inflammatory cytokines. It can also be linked to psoriatic arthritis, which affects the joints. Treatment includes topical steroids, phototherapy, and systemic immunosuppressants.
Scleroderma
Scleroderma is a chronic autoimmune connective tissue disease characterized by abnormal collagen deposition, leading to skin thickening, fibrosis, and vascular dysfunction. It can affect the skin, blood vessels, and internal organs, including the lungs, heart, kidneys, and gastrointestinal tract.
There are two main types:
1. Localized scleroderma - Primarily affects the skin and underlying tissues, often in morphea or linear forms.
2. Systemic sclerosis (systemic scleroderma) - Involves widespread fibrosis affecting the skin and internal organs.
Common symptoms include tight, hard skin, Raynaud’s phenomenon, joint pain, and digestive issues. The exact cause is unknown, but it is believed to involve immune system dysfunction and genetic/environmental factors. There is no cure, but treatment focuses on managing symptoms and slowing disease progression with immunosuppressants, vasodilators, and physical therapy.