In this article:
In general terms, “burns” are wounds that develop when your skin is subjected to excessive heat. While it’s true that most burns result from incoming amounts of heat, you can also incur such wounds without direct thermal exposure, as in the case of electrocution.
So the broader definition of burns would be an excess accumulation of energy in tissues coming into the skin from outside.
The energy may be from UV rays (sunlight) through a glass window, from a chemical that comes in contact with the skin such as lye or acid, or from radiation therapy treatments.
Different Degrees of Burns
For simplicity, burns are categorized based on the depth of injury into the skin, as first, second, or third-degree burn.
- A first-degree burn causes skin redness and heat but does not lead to blister formation.
- A second-degree burn also causes redness and heat and forms a “water” blister. The skin redness blanches with pressure.
- A third-degree burn is a full-thickness burn that destroys the nerve endings in the affected area leading to numbness or loss of sensation. This kind of burn disrupts blood supply in the affected area, causing the skin to turn completely white or charred and visibly swollen. The burn site will usually require skin grafting to heal.
Common Causes of Burns
First-degree and second-degree burns have several common causes.
First-degree burns usually result from a mild sunburn, whereas second-degree burns usually result from touching a hot stove or curling iron, spilling hot water, or a severe sunburn.
Third-degree burns are usually related to fire or hot grease. Hot grease is hotter than water, so it can burn deeper.
Healing Time for the Different Degrees of Burns
First-degree burns are usually healed completely within 3–5 days. Second-degree burns take 5–8 days to heal if the damage is deep.
Third-degree burns need surgical removal of the dead skin and then coverage with a skin graft to restore the pliability and function of the burn area. So, the recovery time for third-degree burns may last as long as 3–4 weeks, even with a good rate of skin healing and no infection.
Proper Dressing for Burns
First-degree burns usually need no dressing or coverings. Most other burns are more comfortable if treated with closed dressings to prevent air exposure and further friction against the burn surface by clothing or simple touching.
In such cases, always keep the affected area clean. Cover it with an appropriate topical antibiotic (such as a triple antibiotic ointment) held in place by a “non-stick” dressing of sterile gauze.
It is important that the dressing is changed when it becomes soiled (at least daily) to prevent infection and worsening of the burn injury.
Prevent Different Kinds of Burns
Here are a few precautionary tips to protect your skin from burn injuries:
- Avoid sunbathing between 11 am and 3 pm to prevent severe sun energy exposure that causes the most damaging sunburns.
- Wear protective clothing, such as long-sleeved tops and broad-brimmed hats, to protect your face and arms from sun exposure.
- Use a good broad-spectrum (UVA and UVB) sunscreen before going outdoors, and reapply it whenever you feel its effect has worn out, especially after washing the skin, in case of extreme sweating, or after taking a swim. Even on cloudy days, the UVA rays from the sun come through and can burn your skin.
- Wear protective gloves when burning trash, handling foods during grilling, or using hot grease for frying to keep your skin shielded from the intense heat.
- Do not use pans with loose handles when cooking!
Do All Burns Need Emergency Medical Care?
A burn qualifies as an injury and should be evaluated and treated as such. Treatment should be urgent but not necessarily in an emergency room. A good rule, though, is to go to the ER if you are unsure of the severity of the burn.
Pain Medicine for Burn Injuries
Topical anesthetic (lidocaine, benzocaine, etc.) creams or lotions work well to ease the pain of sunburns. (1) Usually, an oral antibiotic containing codeine will suffice for deep second-degree burns. Serious deep burns may require physician-administered pain medicine for relief.
Healing First-Degree Burns at Home
Cold water compresses (even cold milk or cream) can cool the skin and can reduce the amount of damage from burns. (2) Some people apply vinegar topically, which provides an evaporative cooling effect on the skin, which helps make first-degree burns less painful.
Standard Treatment for Electrical and Chemical Burns
Both of these burn types need the same medical attention, such as fluid replacement and clean (sterile, if possible) wound care.
Either type may need surgical debridement and possibly grafting for healing as well. Of course, the removal of (or neutralization of) the chemical causing the burn is very important in the early care of chemical burns.
Symptoms of Third-Degree Burns
A third-degree or full-thickness burn means dead skin as all skin layers are involved. The skin color is whitish or dull and does not blanch with pressure. The nerve endings have been destroyed, so they may not be as painful as second-degree burns.
The Fatality of Third-Degree Burns
Small areas of the body can have third-degree burns that are not fatal to the person. The areas of third-degree burn do represent skin that is dead and will require reconstructive surgery to cover the lost skin area.
Most patients that die from burns usually have third-degree burns over large areas of the skin surface. An exception to this could be a high-voltage electrical burn that is lethal just due to the tremendous amount of energy coming into the body, which stops the heart from beating.
Reconstructive Surgery for Third-Degree Burns
All third-degree burns require reconstructive surgery or at least skin grafting to undo the damage.
Depending on the location of the burn and structures exposed (joints, nerves, blood vessels, etc.), proper treatment may require rotating a pedicle flap of skin and deeper tissues with intact arteries and veins over the wound to restore or preserve the full function of the area.
Full-thickness eyelid burns or burns over finger joints would be examples of burns that need true reconstructive surgery.
Is Skin Grafting Required for Blisters?
Blisters should not require skin grafting, but it is wise to treat it with care to keep the blister covering intact. Doing so minimizes the pain, which would be more intense if the blisters break.
An intact blister allows healing to occur as a “protective” cover is in place. However, a blister can be punctured at the point where it is attached to the skin to remove the excess fluid while keeping its covering intact.
A sewing needle that has been sterilized (by holding it in a match flame until red) can be used to puncture the blister. However, this technique is invasive and can lead to further skin damage or infection if not done carefully, so expert supervision is advised.
Possible Complications of the Different Degrees of Burns
First-degree burns damage the collagen and matrix structure of the affected skin layer and, thus, add to the cumulative aging appearance of the skin.
Second-degree burns destroy the melanocytes, or pigment making cells, which are located in the epidermal layer (superficial) of the skin. Permanent irregular pigmentation may occur as a result. Second-degree burns can cause scarring to the skin. Third-degree burns will almost certainly leave permanent residual scarring.
Almost half a million people in America visit the emergency room for accidental burns every year, which goes to show how common this form of injury is.
The treatment for burn injuries depends upon how deep or extensive the tissue damage is. While mild first-degree burns are quick to heal on their own, regular dressing and pain medication are needed to cope with second-degree burns.
Third-degree burns, on the other hand, can be too painful to bear and require reconstruction and grafting surgeries to undo the deep tissue damage. If you get deep burns on large areas of the skin, seek prompt medical assistance like your life depends on it because the chances are that it does. Always see a physician whenever in doubt about a burn’s severity or need for medication.
Early home treatment will help prevent scarring in cases of first- and second-degree burns, but surgery is the only way to repair your skin in case of third-degree burns. Meanwhile, delayed treatment or improper wound care can invite secondary skin infections at the burn site.