How Different Degrees of Burns Are Treated

The seriousness, or severity, of a burn usually depends on two key factors: how deep it goes (how far into the layers of skin the burn damage extends) and how wide it is (how much total body surface area it covers).

This article will discuss how to determine a burn's severity, how to treat a non-serious burn yourself, and when to get emergency care.

Burn Degrees

The severity of a burn depends on how deep it is, which is measured in degrees. First-degree burns are superficial (on the surface) while second- and third-degree burns extend deeper into the layers of the skin.

First-Degree Burns

A first-degree burn refers to a burn injury in which the surface of the skin is damaged, but the epidermis, the outermost layer of skin, is still intact. The skin is therefore able to perform its functions to control temperature and protect the body from infection or injury. 

First-degree burns can usually be treated at home and don't require emergency treatment or hospitalization.

Second-Degree Burns

Second-degree burns are those that penetrate through the epidermis and into the dermis, the second layer of skin. This layer is where hair follicles and sweat glands are. Second-degree burns also are known as partial-thickness burns.

Blisters are the first sign of a second-degree burn. As the epidermis is destroyed, it begins to separate from the dermis. Fluid builds beneath it, causing blisters. Eventually, the blisters will spread into one another until the very thin epidermis falls away, exposing the raw dermis underneath.

Once the epidermis has separated from the raw dermis, the person begins to lose fluid, heat, and the ability to block infection. The exposed nerve cells of the dermis also mean second-degree burns are the most painful.

Third-Degree Burns

Third-degree burns, also called full-thickness burns, are those that destroy both the epidermis and dermis. Someone with a third-degree burn has the same troubles with fluid loss, heat loss, and infection that come with second-degree burns.

Third-degree burns also cause nerve death, so the person may not be able to feel anything in the area of the burn.

At a glance, there's no easy way to tell the difference between a deep second-degree burn and a third-degree burn.

What Does Each Degree of Burn Look Like?

In first-degree burns, the skin generally looks dry and may have a raised area or welt. The skin won't blister, and lower layers of skin won't be visible.

Second-degree burns often blister. You may be able to see distinct layers of skin around the well-defined edge of the burn as well. A severe second-degree burn may have a glossy, red appearance without blisters, and drops of liquid may form on the surface.

Third-degree burns can appear dry, leathery, and dark red, or they may look white, blackened, or charred. You may see yellow fatty tissues where layers of skin are gone. Because the nerve endings have been destroyed, third-degree burns aren't usually painful to the touch.

Burn Surface Area

The width of the burn is expressed as a percentage of the body's surface area. This is only used for burns that are at least second-degree. Second-degree burns that cover more than 10% of the body's surface area are generally considered very serious.

To calculate the total burned surface area, healthcare providers use the Rule of Nines. The body is divided into 11 sections that each make up about 9% of the body's skin. The sections are:

• Head and neck
• Right arm
• Left arm
• Chest
• Abdomen
• Upper back
• Lower back
• Right thigh
• Left thigh
• Right lower leg
• Left lower leg

The genitalia make up the final 1%.

To apply the rule, you add up areas of the body burned deeply enough to cause blisters. If you have been burned or you are with someone who has, you can provide that information when you call 911. This may help first responders quickly determine whether the person needs to be transported to a burn unit.

You can also measure the area of a burn with the palm of your hand. In most people, the palm makes up about 1% of your skin's surface area. In general, if a burn covers more than three palms or 3% of the total body surface area in an adult, you should get immediate medical attention. (For children, the guideline is 2%.)

Specific Types of Critical Burns

Burns on certain parts of the body can be considered critical (extremely dangerous) regardless of the overall size of the burn. A burn to one of these areas is considered critical, even if it is the only thing burned:

• Burns that completely encircle a hand or foot
• Face
• Genitals

Burns still must be second-degree or worse to be considered critical.

How Burns Are Treated

The basics of burn treatment are the same no matter how serious they are, but with additional steps added on for the more severe ones.

Treating First-Degree Burns

The first action after a burn should be to run cool (not cold) water over it or apply cold compresses for at least 10 minutes. Don't ice it! Using something too cold can cause more damage to the skin's tissues. Once the area is cooled down, you can clean the burn with mild soap.

You can use petroleum jelly or aloe vera to help cool a burn and ease the pain. Topical antibiotic ointments are okay if you know the person isn't allergic to them. Don't use creams, lotions, or oils. Ignore the myths about butter or toothpaste—they don't help, they can trap heat inside the skin, and they invite infection.

Then apply a sterile bandage that won't stick to the burn. Over-the-counter (OTC) pain relievers can help ease the discomfort.

Treating Second-Degree Burns

When dealing with second-degree burns, follow the same steps as for a first-degree burn, being careful not to break any blisters. The blisters are part of the healing process, and opening them can lead to infection.

If you think the burn may require emergency treatment, do what you can to cool it while waiting for an ambulance, and use a cool compress on the way to the hospital. That can keep the damage from becoming worse.

When choosing an OTC pain reliever, choose an anti-inflammatory type as second-degree burns can cause swelling. OTC anti-inflammatories include Advil (ibuprofen) and Aleve (naproxen).

You can also elevate the area above the heart to lower inflammation. Your healthcare provider may prescribe an antibiotic cream such as silver sulfadiazine to prevent infection while you heal.

Treating Third-Degree Burns

Intravenous (IV) fluids are often given to patients who have third-degree burns. This combats dehydration and shock and stabilizes the person. Other lifesaving measures may also be necessary, depending on the severity of the burn. Eventually, skin grafts taken from undamaged areas of the body may be used to replace the burned skin.

Severe burns can result in long hospital stays. Multiple procedures may be required. The person needs to be monitored for complications such as:

• Dangerously low blood pressure
• Excess fluid buildup and swelling (edema)
• Organ failure
• Pneumonia
• Severe infection
• Sepsis
• Heart rhythm abnormalities (in electrical burns only)

When to Get Emergency Treatment

A first-degree or mild second-degree burn doesn't usually require immediate medical attention. However, certain factors can complicate healing and lead to more problems down the road. Get treatment right away if any of the following apply:

• The burn covers a large area (3%+ for adults, 2%+ for children)
• It's on a baby, elderly person, or someone with diabetes or a weakened immune system
• It's on the face, hands, feet, or genitals
• It goes all the way around a limb or extremity
• It covers a joint
• It's from a fire, electricity, chemicals, or inhalation

What Should Not Be Done to Treat Burns

Knowing what you shouldn't do is just as important as what you should. In the case of burns, here is what not to do:

• Do not use household products as burn treatments (e.g, butter, oil, ice, eggs).
• Do not remove clothing that's stuck to the burn.
• Do not pop blisters or remove dead skin.
• Do not use cold water on a burn.
• Do not blow or breathe on the burn.
• Do not put the person's head on a pillow if their airway has been burned from something they inhaled.
• Do not allow the person to eat or drink if they have a severe burn.

Summary

Burns are categorized as first, second, or third-degree burns depending on how deep into the skin they go and how much of the body's skin has been burned. First-degree burns are not serious and can be treated at home. Second- and third-degree burns are considered serious and require medical attention. Third-degree burns in particular are considered an emergency.

A Word From Verywell

Burns can be caused by many things, including hot water, steam, fire, electricity, and certain chemicals.

The best thing to do is to try to prevent burns from happening at all. Most burns happen in the kitchen, so it's important to be careful when boiling water or lighting the stove (especially around children). If you or someone with you gets burned, act quickly so it can be treated properly.