Skin burns – 1st degree, 2nd degree, 3rd degree and what to do about them

Patients frequently come into the medical clinic with burns.  Several possible sources of exposure can lead to skin burns including hot water or steam, hot objects or flames, chemical, electricity or exposure to the sun.

Since moderate to severe burns can cause serious complications, it is important to recognize the signs of a serious skin burn so you can be evaluated by a healthcare provider.

When to seek help:

1)    If the burn is on or near a joint such as the fingers, feet or hands

2)    If the burn is on the genital area

3)    If the burn goes all the way around (encircles) an arm, leg, foot, finger or your chest

4)    If the burn is larger than 3 inches or deep

5)    If the patient is younger than 5 years old or older than 70 years old

6)    If there is increasing pain, swelling, redness or pus-like discharge or fever > 100.4 degrees F.

Burn classification:  The classification system that we used in the past was based on the thickness of the burn.  The new classification is as follows:

1)  Superficial burn or 1st degree involves only the top layer of skin.  They heal within 3-6 days.shutterstock_56132251

2)  Partial-thickness  or second degree burns involve the two top layers of skin.  These burns are painful with air movement or temperature changes and form blisters.  Partial thickness burns turn white when pressed.  These burns usually health within 7-21 days.  The skin that was burned may become darker or lighter color permanently in some patients. shutterstock_127655633

3)  Deep partial-thickness burns were previously called 3rd degree burns and are painful with deep pressure.  They form blisters and do not turn white with pressure.  These burns take longer than 21 days to heal and usually develop a scar that may be severe.  If the skin blisters immediately, it is at least a deep partial-thickness burn.  bb2_2

4)  Full Thickness Burns:  Extend through all layers of the skin and destroy it completely.  The burned area usually does not hurt and is waxy white to leathery gray in color and the skin is usually dry.  Full-thickness burns do not heal without surgery.  These burns used to be called 4th degree burns.  shutterstock_101309467

Treatment:  Most of the time small superficial or partial-thickness burns can be treated at home, but deeper wounds should be evaluated by a medical provider.  Treatment in the home:

1)   Clean the wound:  If clothing is stuck to the wound, seek care by a medical provider.  Gently wash the burned skin with soap and water.  Do not use alcohol, iodine or other cleansers.

2)   Cool the wound:  After cleaning, you may apply a cold compress or soak the skin in cool water for comfort and reduce pain.  Do not put ice directly on the wound itself however.

Infection prevention:  Apply a small amount of antibiotic ointment such as bacitracin or silvadine cream may be applied.  A minor burn may be covered with a bandage or dressing.  If there are blisters, these should be covered with a clean bandage or dressing.  Do not pop the blisters with your fingernail as this may increase the risk of infection.  Leave the blisters alone or gentle pop them on the side of the blister sterile needle if they are large.  Use a non-stick dressing such as Vaseline impregnated gauze or Telfa dressing to cover the wound.

If your tetanus has not been updated within 5 years, you need a tetanus booster if the burn is superficial partial-thickness or deeper.

Burn Prevention:

1)   Keep matches, lit candles and lighters out of the reach of children

2)   Do not smoke when sleepy

3)   Use a cool-mist humidifier instead of a warm mist humidifier

4)   Apply sunscreen liberally to prevent sunburn and stay out of the sun when possible

5)   Be careful when placing a child in a car seat or stroller because the metal or vinyl can become hot

6)   Set your hot water thermostat to lower than 120 degrees F

7)   Keep children away from fireplaces, hot stoves and ovens

8)   Children’s sleepwear should be non-flammable.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO



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