How Different Degrees of Burns Are Treated

Determining the 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).

Burn Degrees

Depth is measured in degrees of burns. First degree burns are superficial and don't open you up to infection or cause you to lose fluid.

Second-degree burns, also known as partial-thickness, have damaged not only the outermost layer of skin but extend into the main part of the skin where the hair grows and the sweat glands weep.

Third-degree burns are also called full-thickness and have killed the skin all the way to the fatty tissue underneath (or even into the muscle).

First-Degree Burns

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

A first-degree burn is considered a superficial burn. When assessing the severity of burns to determine if a patient needs hospitalization, healthcare providers ignore first-degree burns.

Second-Degree Burns

This means damage that has extended through the epidermis and into the dermis (the second layer of skin).

Second-degree burns also are known as partial-thickness burns. In determining the severity of burns, the presence of second-degree burns indicates a loss of skin function.

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 victim begins to lose fluid, heat, and the ability to block infection. The raw nerve cells of the dermis also mean second-degree burns are the most painful.

Third-Degree Burns

This indicates the burn has destroyed both the epidermis and dermis. The victim has the same trouble with fluid loss, heat loss, and infection that come with second-degree burns.

Full-thickness burns also cause nerve death, so the victim may not be able to feel anything in the area of the burn.

There's no easy way to tell the difference between a deep partial-thickness burn (second degree) and a full-thickness burn (third-degree) when looking at it in the field.

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, as first-degree burns aren't considered critical and don't need special treatment. Burns that are at least second-degree and cover more than 10% of the body's surface area generally are considered critical.

To determine the total burned surface area in the field, professionals use the Rule of Nines, in which the body is divided into eleven 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 makes up the final 1%.

To apply the rule, you add up areas of the body burned deeply enough to cause blisters. If you can give that information to 911 or first responders, it may help them quickly determine whether the person needs to be transported to a burn unit.

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

Specific Critical Burns

While most burns are determined to be critical by their depth and width, burns on important parts of the body can be considered critical regardless of the overall size of the burn itself. Burns to these areas are considered critical, even if this is the only thing burned:

• Burns that completely encircle the hands or feet
• Face
• Genitals

Burns still must be second-degree or worse to be considered critical. First-degree burns are never counted.

How Are Burns Treated?

The basics of burn treatment are the same regardless of severity, but with additional steps added on for the more serious ones.

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 compromised 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

Get emergency medical treatment for all third-degree burns as well as for severe second-degree burns. Some second-degree burns can be treated at urgent care instead of the emergency room. If you have any doubt about the severity, go to the hospital.

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 ten minutes. Don't ice it! Using something too cold can cause more tissue damage. 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, and ignore the myths about butter or toothpaste—they don't help, they can trap the 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 first-degree, being careful not to break any blisters. The blisters are part of the healing process, and opening them also 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 or, with a compress, on the way to the hospital. That can keep the damage from becoming worse, so it's important not to wait for the professionals.

When choosing an OTC pain reliever, an anti-inflammatory might be better, as second-degree burns can cause swelling. OTC anti-inflammatories include Advil (ibuprofen) and Aleve (naproxen). You can also elevate the area to lower inflammation. Your doctor may prescribe an antibiotic cream such as silver sulfadiazine to prevent infection while you heal.

Treating Third-Degree Burns

Third-degree burn treatments at the hospital or burn center are often treated with fluids to combat dehydration and shock and get the person stable. Other life-saving measures may 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 need to be performed and 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)

What Should Not Be Done to Treat Burns?

Sometimes, what you shouldn't do is just as important as what you should. In the case of burns, the list of "don'ts" for burns includes:

• 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
• In the case of an airway burn from inhalants, do not put the person's head on a pillow
• Do not allow the person to eat or drink if they have a severe burn