**Burn Etiology and Pathogenesis**

**Burn Etiology and Pathogenesis**

#### Yesim Akpinar Kara Yesim Akpinar Kara Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.71379

#### **Abstract**

As a trauma type, "Burn" is one of the high-frequency accidents in the world. It is mostly caused by electricity, hot water, and chemical agents. A trauma can have acute effects on burns, skin, and other organ systems. These complications might be seen as myocardial infarction, thromboemboli, respiratory, and renal failure. In case of acute burns, the skin surface is severely destroyed. During this period, infection may develop on damaged skin. Therefore, in the treatment of burn wounds, protecting the damaged skin and multidisciplinary approaches are needed for preventing scar formation while healing process.

DOI: 10.5772/intechopen.71379

**Keywords:** burn etiology and pathophysiology, burn types, burn degrees, burn scar etiopathogenesis

#### **1. Introductıon**

Burn is defined as destruction found in the epidermal tissue, dermal tissue, or deeper tissues, due to contact with thermal, chemical, or electrical agents. According to the World Health Organization, thermal burns account for an estimated 6.6 million injuries and 300,000 deaths each year worldwide [1]. Burn pathophysiology can be broken into local and systemic response. When excessive heat is transferred to the skin, it radiates outward from the point of initial contact and forms a local response with three zones in all directions. The systemic response following a burn can be massive. In a large burn, two clinically significant processes occur. The release of systemic inflammatory mediators and cytokines result in increased capillary permeability and wide scale extravasation of fluid and proteins from the intravascular to the extravascular space.

During wound healing, proinflammatory factors, such as interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha (TNF-alpha) are released. This promote chronic inflammation and

Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons

various inflammatory cells are formed in the affected tissue. Angiogenesis starts into the damaged tissue. Tumor necrosis factor-alpha, prostaglandin E2 also play a role in the formation of inflammatory response in wound healing. Any damage to the formation of this response can result in scarring after the burn. The primary cytokine responsible for scar formation is transforming growth factor-beta (TGF-β) secretion which is released from the other inflammatory cells and myofibroblasts. Hypertrophic scar does not develop when the reticular layer is not affected in burning. As a result, inflammatory cells, fibroblasts, newly formed blood vessels, and collagen deposits develop hypertrophic scar tissue in the reticular layer [2, 3].

water to the burned area could prevent pain. During World War I, burns related to the use of sulfur-containing chemicals were observed and advanced treatment facilities were estab-

Burn Etiology and Pathogenesis

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http://dx.doi.org/10.5772/intechopen.71379

Although the awareness level of the individuals is increasing nowadays and preventive technologies are developed, the burn is still one of the important causes of mortality and high morbidity. It is known that more than 6 million people are exposed to burns every year in the world, and that the mortality rate due to burns is 6–7%. About 75% of the deaths are due to CO inhalation and at the scene primarily [8]. Another cause of mortality is sepsis. As the total body surface area affected by burn increases, the mortality rate also increases [8]. Burns are most commonly seen in the upper and lower extremities [8, 9]. Burn traumas often result from an accident or neglect. About 80% of the burns arise from individual errors and 70% occur at home [4]. Burn epidemiology varies with age. Child age group and elderly population are more at risk. Studies show that more than half of the cases are in the child age group. About 19% are under the age of 5 and 12% are over 60 years old [1]. While boiled water and flame burns are seen most commonly, they are followed by electrical and chemical burns. While hot water burns are seen in approximately 70% of the pediatric age group, burns due to flame at home or office are seen in adults [10]. In a study conducted in Tokyo, 82% of cases were due to hot water and 11% of cases were due to flames in children under 16 years of age [11]. In the study of Aytaç et al. causes of burns were found as 68.8% hot water, 1.5% flame, 3.8% hot

At least 44°C of heat is required for the skin to be burned. Besides, the duration of the heat is also important; transepidermal necrosis occurring with 70°C of heat in a second, occurs in

Burns can be grouped according to thermal, chemical, electricity, and radiation [12]. The causative of burns should be known since a different treatment protocol is applied in each case. Thermal burns that occur with direct effects of flames with high levels of heat, contact with hot objects, hot liquids, or hot vapors are commonly seen. The duration of the contact and the degree of the temperature determine the degree of cell damage [1]. Chemical burns due to acid or alkali salts and solutions may cause burns due to corrosive effects of these substances. Other than these, burns can also develop due to electrical current, radiation, ultraviolet, and laser rays [4]. Serious burns due to flames of weapons, explosives, and combustibles can occur during warfare [12].

It develops in two different ways as hot water and flame burns. Thermal burns are skin injuries caused by excessive heat, typically from contact with hot surfaces, hot liquids, steam,

lished for the treatment of burns after World War II [7].

material contact injuries, and 1.1% chemical burns, respectively [9].

**4. Epidemiology**

**5. Etiology**

**5.1. Thermal burns**

45 minutes with 47°C of heat [4].
