Heat-mediated changes to the hands and feet mimicking washerwoman's skin

Abstract

If the palms of the hands and the soles of the feet of burnt bodies are not or only partially charred, whitish discoloration and wrinkled detachment of the epidermis is often observed. The findings are strongly reminiscent of the so-called washerwoman's skin, as seen after exposure to a moist environment for at least several hours. However, this is not to be expected after exposure to dry heat. What might be conceivable is a swelling of the skin due to the effect of the water used for fighting the fire. On the other hand this phenomenon is also observed in burnt bodies, which demonstrably have not come into contact with water, so that formation seems to be caused by a different mechanism. Moreover there are also histological differences between real washerwoman's skin and the pseudo-washerwoman's skin of fire victims. Whereas in genuine washerwoman's skin the stratum corneum is disaggregated and perinuclear vacuoles are found in the stratum germinativum, burnt bodies with pseudo-washerwoman's skin show detachment of the epidermis due to serum-filled blisters with elongation and palisade arrangement of the nuclei in the stratum basale. Consequently these changes agree with second-degree burns.