Burn Degree

The term “burn degree” refers to the extent of injury to the skin caused by a burn injury. Generally when these words are used, the terms first degree, second degree and third degree are used to denote the seriousness of burn degree, or the extent of injury caused.

First Degree Burns

This burn degree is the least serious of all burns. Akin to sunburn, first degree (superficial) burns cause erythema (redness) and pain, but blisters are not present. Skin that has suffered a first degree burn will blanch when touched. A low grade fever, mild swelling, itchiness and headache may also be present. Although these burns can be quite uncomfortable, they do not cause lasting damage in the form of scarring. However, repeated first degree burns may predispose to the later development of skin cancer.

Treatment for first degree burns involves cooling the burned area. This can be accomplished by running cool water over the burn for 10 minutes, or by applying towels that have been soaked in cool water. Take care not to cool the victim too much. Never apply butter or other substances that may lead to infection. Application of aloe gel or cream may improve pain. If pain is a problem, acetaminophen or ibuprofen may be used (do not give aspirin to children). If large portions of the body are affected, especially in children, medical attention should be sought.

Second Degree Burns

This burn degree is more serious than first degree burns. In second degree (partial-thickness) burns, both the epidermis and the dermis are affected. The epidermis is the outermost layer of the skin, while the dermis is the middle layer of the skin containing hair follicles, blood vessels and nerve endings. With second degree burns, blisters form very quickly, generally within the first 24 hours. These burns are generally reddened, moist and painful. Pain usually decreases the deeper the burn extends into the dermis, due to destruction of nerve endings that carry the sensation of pain. There may be a moderate amount of edema (swelling) with these burns; improper care of these burns early on may cause them to worsen into full-thickness burns. Second degree burns can take anywhere from one to three weeks to heal, and may cause scarring.

Third Degree Burns

This burn degree is reserved for severe burns that invade down into the subcutaneous tissue. Third degree (full-thickness) burns may damage the structures that lie under the skin, such as bones, tendons, ligaments and nerves. The color of these burns may range from white to a black, charred appearance. Third degree burns are not in themselves painful due to destruction of nerves, but a victim may complain of pain if there are also areas of second degree burns. Third degree burns will never heal on their own and often require months to heal, sometimes requiring numerous surgical procedures for skin grafting and cosmesis. There is often severe scarring as a consequence of these burns.

The majority of burns are caused by direct contact with a thermal heat source, while others are caused by electrical energy, chemicals, flame or steam. Regardless of the cause of the burn, burn degree must be accurately identified so that proper treatment can be provided, thus preventing complications and unnecessary scarring. In addition, burn degree helps practitioners decide which patients require transfer to a facility specializing in the care of burn victims (burn centers). Second degree burns of more than 10% of the total body surface area (TBSA) and third degree burns of more than 5% of the total TBSA should be transferred to a burn center, according to the American Burn Association, who has established criteria for burn center admission.

The terms first, second and third degree burns were replaced by the terms superficial, partial-thickness and full-thickness burns because the latter terms more accurately describe the damage caused by these injuries to the skin. Although the latter terms are used more often these days, the old nomenclature is acceptable.