As our first line of defense and largest organ, the skin is vulnerable to trauma. It protects and interacts with the environment around us while providing a large water resistant wrapper. Burns to the skin which are common dilemmas can be a minor nuisance or severe enough to be life threatening. The severity is not always obvious. There are some simple ways to prevent, understand, and treat burns when they arise. Thermal burns as a direct result of excessive exposure to heat are certainly most common. Chemicals, electricity, radiation can also cause similar damage to the skin. Regardless of the damaging source, characterizing the size, location on the body and depth of a burn dictate the treatment and expectation for recovery.

A first, second or third degree burn estimates depth of the skin damage. First-degree burns are typically minor causing only some redness and mild discomfort. By definition, the damage is superficial and limited to only the outer layer of skin. A mild sunburn without any blistering is a good example of a first-degree burn. A Second-degree burn causes blistering. This indicates deeper involvement of the dermis layer of skin also know as partial thickness damage. Since the underlying nerves are still very much alive there is significant and increasing discomfort associated with partial thickness burns. Both the depth of the damage, the location on the body and overall size involved contribute to the pain. The waterproof barrier is compromised and it can be difficult to regulate fluid balance if the area on the body involved is large. Moreover, surface bacteria have an unimpeded path to get inside and breed, fueled by damaged and sometimes nonviable tissue. The risk of infection goes up significantly. Third-degree burns damage the entire thickness of skin. It usually remains in place if the area is small. However, the appearance is ironically "better" than second-degree damage. The appearance is typically off-white to light gray in color and painless, even numb to the touch. It has a more clean appearance than the more painful partial thickness burn. The third-degree injury has essentially killed the full thickness of skin, its nerve endings, cauterizing small blood vessels depriving it of any color or pain sensation even though it represents a much more serious injury.

Recognizing the depth of skin damage, overall size of the area and location on the body will dictate how aggressively it has to be treated. The Rule of Nines is a simple way to estimate the amount of body area involved for an adult with serious second and third degree burns. Its use is solely as a means for initial assessment. It is by no means, the most important element in describing a burn. The body's surface area is divided into eleven sections each representing approximately nine percent of the total surface area: head, chest, right arm, left arm, abdomen, upper back, lower back, right thigh, left thigh, right lower leg, left lower leg. With this as a reference one can quickly estimate the amount of area involved with a serious burn.

Initial first aid is always about cooling the area with cool clean compresses or running water. The goal is to remove any remaining heat from the skin. Avoid using ice as it can compromise the already damaged circulation. Refrain from adding any agents to buffer or neutralize chemicals. Neutralizing agents can generate heat from the chemical interaction. Simple irrigation with cool water and clean moist compresses are more important and initially satisfactory for pain relief as well. An electrical burn can be very deceptive. Little outward damage is evident. Electricity has potential to travel over a wider area causing more extensive tissue damage. If the amount of current and grounding are sufficient, subtle more severe problems are caused by electrocution. Further evaluation by a medical profession is always prudent to assess the full extent of damage.

Treatment is focused on preventing infection and pain management. The skin is very resilient and in most cases will regenerate slowly over two to three weeks. During this time, daily dressing changes are required using antibiotic cream as a barrier to infection with sterile dressings. Removal of devitalized tissue is also necessary with some partial thickness burns. More severe burns can take much longer and may require surgical intervention to facilitate healing. Anti-inflammatory medications such as ibuprofen or stronger pain relievers are often necessary during the initial period and for dressing changes. If a burn is located over a moving joint, physical therapy can maintain range of motion by gently stretching the skin during the healing process.

Use of protective gear and following instructions are the basic but nonetheless important steps to preventing chemical burns. When working around an open flame or radiant heat source, great care is needed to avoid prolonged exposure or accidental contact. If outdoors for work or recreation, proper use of sunscreen and protective clothing can go great lengths to avoiding minor or more extensive sun damage. Avoid life-long injury, time loss from work or recreational activities with a small investment of thoughtfulness.