title: A special type of scald caused by prolonged exposure to slowly heated water.
abstract: When skin is subjected to water temperatures gradually rising from moderate to critical ranges for a prolonged period of time, the resulting scalds will initially present as reddening, followed by blistering and at last by full-thickness burns. On changing from second- to third-degree burn, the blisters stop to become enlarged and solidify due to heat-induced coagulation necrosis. Such gradually intensifying tissue damage results in multiple firm skin blisters together with third-degree burn of the affected area. The initially serous blister fluid assumes a jelly-like consistency as the proteins undergo denaturation. Scalds of this special type may occur in persons taking a bath and becoming incapable to act so that the warm water tap remains turned on or a hairdryer continues to work after having been dropped into the bath water. On the basis of two relevant fatalities (suicidal electrocutions in bathtubs by means of hairdryers), the macroscopic and histological appearance of blisters which only secondarily turned into a full-thickness scald is compared with blisters in genuine second-degree scalds. The blister fluid of the latter ones was also investigated as to their protein composition and hemoglobin concentration.
authors.affiliation: Institute of Forensic Medicine, Freiburg University Medical Center, Albertstrasse 9, 79104 Freiburg, Germany. Electronic address: rebecca.pircher@uniklinik-freiburg.de.
authors.forename: R
authors.initials: R
authors.lastname: Pircher
authors.affiliation: Institute of Forensic Medicine, Freiburg University Medical Center, Albertstrasse 9, 79104 Freiburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Pollak
authors.affiliation: Institute of Forensic Medicine, Freiburg University Medical Center, Albertstrasse 9, 79104 Freiburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Vogt
authors.affiliation: Division of Clinical Chemistry, Department of Medicine, Freiburg University Medical Center, Hugstetter Strasse 55, 79106 Freiburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Epting
authors.affiliation: Institute of Forensic Medicine, Freiburg University Medical Center, Albertstrasse 9, 79104 Freiburg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Kramer
authors.affiliation: Institute of Forensic Medicine, Freiburg University Medical Center, Albertstrasse 9, 79104 Freiburg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Geisenberger
mesh_terms: D001494:Baths; D001768:Blister / Q000378:metabolism* / Q000473:pathology*; D002056:Burns / Q000473:pathology*; D004556:Electric Injuries / Q000150:complications; D005260:Female; D049429:Forensic Pathology; D006454:Hemoglobins / Q000378:metabolism; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000378:metabolism; D011506:Proteins / Q000378:metabolism
chemical_list: D006454:Hemoglobins; D011506:Proteins
keywords: Bathtub; Blister fluid; Burn blister; Electrocution; Protein electrophoresis; Scald