Burn injuries can be caused by many things including high heat, extreme cold, electricity, chemicals, friction or radiation. Depending on the time and intensity of the exposure, the burn damage to tissues and cells can vary.
The severity of burns is classified based on the depth and area of injury. Depths of burns are categorised into superficial, superficial partial-, deep partial- and full-thickness injuries where the damage starts from the top layer (epidermis) to the second layer of skin (dermis) followed by the subcutaneous fat, muscle and even bone in the most extreme cases.
Burns are different from other cutaneous wounds with three distinguished zones of injury on the surface. The innermost zone of coagulation is the primary site of injury that consists of damaged tissue where all the cells rapidly undergo necrosis—a condition in which body tissues die due to a lack of blood supply. The middle zone of stasis is a region consisting of partial-thickness skin damage along with some cellular damage and restricted blood flow (ischemia) where the injury is potentially reversible with proper and timely intervention. Finally, the outermost zone of hyperemia is characterised by swelling and redness caused by inflammatory responses to the injury. In this zone, innate immune responses are stimulated by the activation of neutrophils, monocytes, macrophages and T cells to protect the injured tissue from pathogens.
Eventual healing comes about after a complex cascade of overlapping processes that first involves the immune cells in the inflammation phase fighting infection, followed by the reconstitution of the damaged tissue layers through the recruitment of skin cells in the proliferation phase; and finally, the remodelling phase where the newly-developed tissue matures strengthens and stabilises.