Burn Pictures: A Close Look at First, Second, and Third Degree

This is a good example of a first-degree sunburn. Sunburns can also become second-degree burns. The differences between burn degrees has to do with the depth of the burn. it's the thickness of the skin that was injured. If only the surface of the skin, the top layer, was burned, we call that a first degree. First degree burns like this one are:

• Redness
• Hot to the touch
• Irritation
• Dry
• No blisters or bubbles

First-degree burns don't blister. Blistering indicates the burn got deep enough to injure the second layer of skin. When that happens, the skin layers start to separate, which leads to blistering.

Blisters are the hallmark of second-degree burns. In this case, the burn is also considered severe because of its location (hand) and its potential to cause a loss of function to the patient.

Hallmarks of a Second-Degree Burn

Second-degree burns have all the same signs as a first-degree burn, plus:

• Swelling
• Severe pain
• Blisters
• Sloughing (top layer of skin falls away, see the next picture)
• Weeping fluid

A swollen burn can put pressure on nerve cells and restrict blood flow in parts of the body that aren't even involved in the burned area. When burns go all the way around an arm or a leg, it can result in what's known as compartment syndrome.

In the worst case scenario, compartment syndrome can lead to dying tissue. Unfortunately, that is a process that perpetuates itself, because the dying tissue gives off toxins that poison the areas around it, increasing the overall damage. The process can go on long enough to kill the victim.

When emergency healthcare providers determine the severity of a burn, they look for several factors. One trigger to call a burn severe is if it reaches all the way around an arm or a leg. Another is if the burn involves the hands or feet. We worry that swelling could lead to an amputation.

Deep second-degree burns will eventually shed the top layer of skin. This is called sloughing.

Second-degree burns can develop over time if not treated promptly. The trick is to stop the burning process as soon as possible with cool running water. Flush the area with water for 20 minutes to return the tissues to their normal temperature.

Remember, tissue continues to burn even after the heat source is gone, which is why cooks take the steaks off the grill a little early. If you want the skin to stop burning, you'll have to actively cool it down.

While technically an abrasion, road rash is an example of friction burn. This one is pretty severe, but you can get friction burns from all sorts of things. We've all heard of rug burn and rope burn.

Look for:

• Jagged, torn top layer of skin
• Raw dermis
• Weeping fluid
• Possibly oozing blood

Since burns are essentially just damage to the layers of skin, road rash treatment and burn treatment are very similar.

Figuring out the degree of a burn depends on which degree you're trying to determine. It's easy to identify a first-degree burn: The skin is red. It's easy to identify a shallow second-degree burn: Blisters develop.

Third-degree burns are much more difficult. Oftentimes, it takes a professional burn unit to really make the call.

In this case, when an oven door sprang back up before this victim was ready, it burnt her arm pretty severely. The burn is almost crusty in this picture, which means it's pretty deep. However, in order for a burn to be considered third degree, it must be full thickness, meaning the damage has to have completely destroyed the thick layer of skin and reached the fatty tissue underneath.

There's just no way to tell that outside of a hospital. In fact, the emergency department is not likely to make that determination, either. What's more important from a practical standpoint is whether the skin is intact. Once the burn gets deep enough to blister—or worse, the top layer of skin starts falling off—it allows bacteria to enter and fluid to leak out.

Even something as benign as a marshmallow can do serious damage. In this case, extra hot chocolate melted a marshmallow and got it hot enough to burn the skin all the way through, causing third-degree burns.

Third-degree burns extend all the way through the dermis and into the subcutaneous tissue beneath. Look for:

• Black center area
• Dry burn
• Surrounded by second-degree burned skin

This picture was taken a few days after the burn happened, during the bandaging process at the doctor's office.