A patient with burns to the skin complains of numbness and difficulty staying warm. Based on this information, diagnose which layers of skin were damaged and the degree of the burns. Explain your diagnoses.
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The layers of the skin affected by the burn in this question are the epidermis and dermis. When a burn occurs to soft-tissue, the fragile, yet strong nerve endings enter in a "protective and chaotic" mode, trying to restore a homeostatic environment. There is also a massive attempt from the body to thermoregulate itself. The heat from the burn is causing the body to release excessive heat to prevent itself from over-heating. Until the brain is signaled to slow this process, heat will rapidly exit the body, thus the difficulty keeping warm. The burn implied in this question actually has a differential diagnoses of the following:
1. Thermal Burn
2. Chemical Burn
These burns are strong enough to damage not only the dermis and epidermis, but also damage the subcutaneous layer. Normally, radiation (sunburn) and cold-related (frost bite) do not penetrate the dermis, due to pain signals activating the body's defense mechanisms (shivering, rubbing hands together) to warm the affected area to its normal temperature.l
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