Injuries Medical Encyclopedia Health Navigator Drug Interactions Drug Notes Health Capsules Smart Sites Back Pain Hip Pain Knee Pain Weight Loss Burns Second degree burn; First degree burn; Third degree burn Definition There are three levels of burns: First-degree burns affect only the outer layer of the skin. They cause pain, redness, and swelling. Second-degree burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering. They are also called partial thickness burns. Third-degreeburns affect the deep layers of skin. They are also called full thickness burns. They cause white or blackened, burned skin. The skin may be numb. Burns fall into two groups. Minor burns are:First degree burns anywhere on the bodySecond degree burns less than 2-3 inches wide Major burns include:Third-degree burnsSecond-degree burns more than 2-3 inches wideSecond-degree burns on the hands, feet, face, groin, buttocks, or a major joint You can have more than one type of burn at a time. Considerations Severe burns need immediate medical care. This can help prevent scarring, disability, and deformity. Burns on the face, hands, feet, and genitals can be particularly serious.Children under age 4 and adults over age 60 have a higher chance of complications and death from severe burns because their skin tends to be thinner than in other age groups. Causes Causes of burns from most to least common are: Fire/flameScalding from steam or hot liquidsTouching hot objectsElectrical burnsChemical burns Burns can be the result of: House and industrial firesCar accidentsPlaying with matchesFaulty space heaters, furnaces, or industrial equipmentUnsafe use of firecrackersKitchen accidents, such as a child grabbing a hot iron or touching the stove This list is not all-inclusive.You can also burn your airways if you breathe in smoke, steam, superheated air, or chemical fumes in poorly ventilated areas. Symptoms Burn symptoms can include:Blisters (intact or ruptured and leaking fluid)Pain (How much pain you have is unrelated to the level of burn. The most serious burns can be painless.)Peeling skinShock (watch for pale and clammy skin, weakness, blue lips and fingernails, and a drop in alertness)SwellingRed, white, or charred skin If you have burned your airways, you may have:Burns on the head, face, neck, eyebrows, or nose hairsBurned lips and mouthCoughingDifficulty breathingDark, black-stained mucusVoice changesWheezing First Aid Before giving first aid, it is important to determine what type of burn the person has. If you aren't sure, treat it as a major burn. Serious burns need immediate medical care. Call your local emergency number or 911. MINOR BURNSIf the skin is unbroken:Run cool water over the area of the burn or soak it in a cool water bath (not ice water). Keep the area under water for at least 5 minutes. A clean, cold, wet towel will help reduce pain.Calm and reassure the person.After flushing or soaking the burn, cover it with a dry, sterile bandage or clean dressing.Protect the burn from pressure and friction.Over-the-counter ibuprofen or acetaminophen can help relieve pain and swelling. Do NOT give aspirin to children under 12.Once the skin has cooled, moisturizing lotion also can help. Minor burns will usually heal without further treatment. Make sure the person is up to date on tetanus immunization.MAJOR BURNSIf someone is on fire, tell the person to stop, drop, and roll. Then, follow these steps:Wrap the person in thick material; such as a wool or cotton coat, rug, or blanket. This helps put out the flames.Pour water on the person. Call 911 or your local emergency number. Make sure that the person is no longer touching any burning or smoking materials.Do NOT remove burned clothing that is stuck to the skin.Make sure the person is breathing. If necessary, begin rescue breathing and CPR.Cover the burn area with a dry sterile bandage (if available) or clean cloth. A sheet will do if the burned area is large. Do NOT apply any ointments. Avoid breaking burn blisters.If fingers or toes have been burned, separate them with dry, sterile, non-sticky bandage.Raise the body part that is burned above the level of the heart. Protect the burn area from pressure and friction.If an electrical injury may have caused the burn, DO NOT touch the victim directly. Use a non-metallic object to move the person away from exposed wires before starting first aid.You will also need to prevent shock. If the person does not have a head, neck, back, or leg injury, follow these steps: Lay the person flatRaise the feet about 12 inchesCover the person with a coat or blanket Continue to monitor the person's pulse, rate of breathing, and blood pressure until medical help arrives. Do Not Do NOT apply ointment, butter, ice, medications, cream, oil spray, or any household remedy to a severe burn.Do NOT breathe, blow, or cough on the burn.Do NOT disturb blistered or dead skin.Do NOT remove clothing that is stuck to the skin.Do NOT give the person anything by mouth, if there is a severe burn.Do NOT place a severe burn in cold water. This can cause shock.Do NOT place a pillow under the person's head if there is an airways burn. This can close the airways. When to Contact a Medical Professional Call 911 or your local emergency number if:The burn is very large - about the size of your palm or largerThe burn is severe (third degree).You aren't sure how serious it is.The burn is caused by chemicals or electricity.The person shows signs of shock.The person breathed in smoke.Physical abuse is the known or suspected cause of the burn.There are other symptoms associated with the burn. For minor burns, call your doctor if you still have pain after 48 hours.Call immediately if signs of infection develop. These signs include:Drainage or pus from the burned skinFeverIncreased painRed streaks spreading from the burnSwollen lymph nodesAlso call immediately if symptoms of dehydration occur with a burn: Decreased urinationDizzinessDry skinHeadacheLight-headednessNausea (with or without vomiting)Thirst Children, the elderly, and anyone with a weakened immune system (for example, from HIV) should be seen right away.The health care provider will perform a history and physical examination. Tests and procedures will be done as needed.These may include:Airway and breathing support, including a face mask, tube through the mouth into the trachea, or breathing machine (ventilator) for serious burns or those involving the face or airwayBlood and urine tests if shock or other complications are presentChest x-ray for face or airway burnsEKG (electrocardiogram, or heart tracing), if shock or other complications are presentIntravenous fluids (fluids through a vein), if shock or other complications are presentMedications for pain relief and to prevent infectionOintments or creams applied to the burned areasTetanus immunization, if not up to date The outcome will depend on the type (degree), extent, and location of the burn; whether internal organs have been affected, and if other trauma has occurred. Burns can leave permanent scars. They can also be more sensitive to temperature and light than normal skin. Sensitive areas, such as the eyes, nose, or ears, may be seriously injured and lose normal function. With airway burns, the person may have less breathing capacity and permanent lung damage. Severe burns that affect the joints may result in contractures, where there is decreased movement and a reduction in function. Prevention To help prevent burns:Install smoke alarms in your home. Check and change batteries regularly.Teach children about fire safety and the hazards of matches and fireworks.Keep children from climbing on top of a stove or grabbing hot items like irons and oven doors.Turn pot handles toward the back of the stove so that children cannot grab them and they cannot accidentally be knocked over.Place fire extinguishers in key locations at home, work, and school.Remove electrical cords from floors and keep them out of reach.Know about and practice fire escape routes at home, work, and school.Set the water heater temperature at 120 degrees or less. Open References References Bethel CA, Mazzeo AS. Burn care procedures. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2009:chap 38.Gallagher JJ, Wolf SE, Herndon DN. Burns. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 22.Holmes JH, Heimbach DM. Burns. In: Brunicardi FC, Andersen DK, Billiar TR, et al, eds. Schwartz's Principles of Surgery. 9th ed. New York, NY: McGraw-Hill; 2010:chap 7.Singer AJ, Taira BR, Lee CC. Thermal burns. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 63. Burns Illustration Burns The depth of a burn determines its severity. First degree burns damage the outer layer of skin (epidermis) and cause pain, redness and swelling (erythema). Second degree burns damage the epidermis and the inner layer, the dermis, causing erythema and blistering. Damage from third degree burns extend into the hypodermis, causing destruction of the full thickness of skin with its nerve supply (numbness). Third degree burns leave scars and may cause loss of function and/or sensation. Burn, blister - close-up Illustration Burn, blister - close-up First degree burns produce only reddening of the skin. Second degree burns produce blistering, as seen here. Burn, thermal - close-up Illustration Burn, thermal - close-up Mild, or first degree burns cause only reddening of the epidermis (outer layer of the skin), as seen in this photograph. Second degree burns cause blistering and extend into the dermis (lower layer of skin). Third degree burns cause tissue death through the dermis and affect underlying tissues. Airway burn Illustration Airway burn Burns to the airway can be caused by inhaling smoke, steam, superheated air, or toxic fumes, often in a poorly ventilated space. Airway burns can be very serious since the rapid swelling of burned tissue in the airway can quickly block the flow of air to the lungs. Skin Illustration Skin The skin is the largest organ of the body. The skin and its derivatives (hair, nails, sweat and oil glands) make up the integumentary system. One of the main functions of the skin is protection. It protects the body from external factors such as bacteria, chemicals, and temperature. First degree burn Illustration First degree burn First degree burns affect the outer layer of the skin, causing pain, redness, and swelling. Second degree burn Illustration Second degree burn Second-degree burns affect both the outer and underlying layer of the skin, causing pain, redness, swelling, and blistering. Third degree burn Illustration Third degree burn Third-degree burns extend into deeper tissues, causing brown or blackened skin that may be numb. Minor burn - first aid - series Presentation Procedure, part 1 To treat a minor burn, run cool water over the area of the burn or soak it in a cool water bath (not ice water). Keep the area submerged for at least 5 minutes. Procedure, part 2 After flushing or soaking for several minutes, cover the burn with a sterile bandage or a clean cloth. Over the counter pain medications, such as ibuprofen or acetaminophen, may be used to help relieve the pain. Minor burns will usually heal without further treatment. Self Care Minor burns - aftercare Home safety - children Bathroom safety - children Skin flaps and grafts - self-care Urostomy - stoma and skin care Tests for Burns AST Albumin - blood (serum) Ketones urine test Total protein Hemoglobinuria test Swan-Ganz - right heart catheterization Chloride test - blood Fibrin degradation products A Closer Look Melanoma and other skin cancers Skin wrinkles and blemishes Peptic ulcers Gout Review Date: 07/22/2014 Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.