Giving Burns the First, Second and Third Degree
Assessing your burn
Burns are a major cause of preventable injury and death in Canada. In 1998, 300 Canadians died and 3493 were hospitalized as a result of a burn injury. Males suffer from burns more often (60%) and three quarters of burn injuries occur in and around the home.
There are many causes of burns. Flame burns are the most common cause of burns in adults (i.e. flammable liquids and campfires), followed by scalding. Children are the more susceptible to scalding (i.e. pulling a pot of boiling water from the stove).
Burns are dangerous because they damage the skin and capillaries resulting in the leakage of large amounts of body fluid to extravascular compartments. Dehydration is the major risk as body fluids can leak through the open wound and evaporate. Restoring fluids is critical in emergency burn management to prevent shock and maintain adequate tissue perfusion. Bacterial infection is also a concern; read more on bacterial infections
Classification of burns
1st degree burn
Painful, red, non-blistering (i.e. sunburn)
What is sunburn
Superficial layer of skin (epidermis) only.
Unless entire body is affected, can be managed in doctor's office
They may heal within 3-4 days, scarring is rare.
2nd degree burn
Deeper than 1st degree and extends into dermis of skin
- Moist, blistering, pink, painful
- Turns white (blanches) with pressure
- Heals within 3 weeks with little scarring.
- Pale, indurated or boggy
- Non-blanching with pressure
- Deeper, so scarring more likely
- Formation of a thick eschar, slow healing (>1month),
- Obvious scarring, hair loss.
3rd degree burn
No sensation, numbing, all layers of skin destroyed
Skin grafting is almost always necessary.
How to Treat Your Burn
Burns often evolve in the first 24 to 48 hours, so be cautious when deciding on the depth of injury. A deeper burn can be quite deceiving and may take a few days to manifest itself. If in doubt as to the severity of a burn, do not hesitate in seeking emergency care. Deep burns often require surgery (i.e. skin grafting, escharotomy) and significant fluid and electrolyte replacement.
Patients with minor burns (1st degree burns, and 2nd degree burns affecting less than 15% of the body surface area (BSA) and 3rd degree burns of less than 2 % of the BSA) can be managed in the doctor's office. The size of your palm is 1% of your BSA. More serious burns are managed in the hospital.
Non-emergency burn management
- Ice and cold water compresses
- Oral (acetaminophen, narcotics only if necessary)
Prevent and treat wound infection (topical antibiotics)
- Topical silver nitrate
- Topical fusidic acid, mupirocin
- Debridement (removal of dead skin)
- 2nd or 3rd degree burns
- Minor burns- ensure adequate hydration
- Complicated burns- fluid resuscitation and management in hospital/emergency setting
- Non-stick, with gauze to absorb any leaking
- Telfa pads
The most important aspect of burn management is knowing which burns have the potential to cause serious harm. Do not hesitate in seeking medical attention. The most serious burns are managed in specialized burn units in hospitals. Read more about taking care of your skin on www.SkinCare patients portal.
Charles Lynde, MD, FRCPC is Assistant Clinical Professor, University of Toronto Canada. His special interests include paediatric dermatology, cosmetic procedures, contact dermatitis, skin cancer, psoriasis and clinical trials in acne, eczema, and psoriasis.
John Kraft, HBSc, is a fourth year medical student at the University of Toronto, with an interest in dermatology.