What to know about burns

The skin consists of three different layers that protect against viruses and bacteria entering the body. These are:

• the epidermis
• the dermis
• hypodermis or subcutaneous tissue

The epidermis

This is the visible outer layer of skin that helps regulate temperature and protect the body. It does not contain any blood vessels.

Superficial or first-degree burns only affect the epidermis, which remains intact. Often treatable at home, a first-degree burn is the least severe.

The dermis

The dermis is the lower level of the skin. Called the papillary region, it consists of collagen, nerve endings, sweat glands, and elastic fibers. It is also the thickest layer of skin, providing flexibility and strength.

A second-degree burn is one that reaches the dermis. This is more serious than a first-degree burn.

Hypodermis or subcutaneous layer

This consists of adipose tissue that stores energy in the form of fat. It is also connective tissue that cushions and insulates the body.

Any burn that destroys all layers of the skin and reaches the hypodermis is a third-degree burn. Third-degree burns are severe and require immediate medical attention.

All types of burns can be painful and produce visible symptoms. Understanding the kind of burn and its severity is essential when assessing medical treatment. There are three levels:

• first-degree
• second-degree
• third-degree

First-degree burn

A first-degree burn is the most common type of burn. Symptoms include:

• dry skin with mild swelling
• changes in skin color
• pain
• itchiness
• sensitivity to the touch

Sometimes blisters and peeling may occur. If touched, the skin may blanch (lighten in color). The epidermis typically remains intact.

While first-degree burns may be painful, long-term damage is rare. Also known as ‘superficial’ burns, common causes include:

• mild sunburn
• tipped over hot liquids
• hot bathwater
• cooking fluids
• hot appliances, such as a cooker or iron
• friction between skin and hard surfaces, such as turf on a sports field, floors, roads, or carpets

First-degree burns often heal on their own within a week. A person may require medical treatment if the burn is over a large area of skin. Speak with a healthcare provider for advice.

Second-degree burn

Second-degree burns affect deeper layers in the skin than first-degree burns and can involve intense pain.

They affect the epidermis and dermis, with the burn site often appearing swollen and blistered. The area may also look wet, and the blisters can break open, forming a scab-like tissue. Doctors also call them partial-thickness burns.

A second-degree burn is more likely to require medical treatment, depending on its location and depth. Causes of second-degree burns include:

• boiling water
• flames from a fire
• hot stoves
• burning candle wax
• steam from an iron
• hot iron
• sunburn in extreme cases over a large area
• chemical burns

Many second-degree burns heal within a couple of weeks, although scar tissue can occur.

Third-degree burn

This is the most severe type of burn and requires medical treatment. Nerve and blood vessel damage often leave the burn site looking pale in color or blackened and charred.

Despite the severity, third-degree burns are often painless because of damage to the nerve endings. Doctors may call them full-thickness burns.

Causes of third-degree burns include:

• a scalding liquid
• flames
• an electrical source
• contact with a hot object for an extended period
• a chemical source

Third-degree burns destroy the epidermis and the skin follicles, which means new skin will not grow back. Anyone who has a third-degree burn needs immediate medical attention.

The treatment of a burn depends on its severity, size, and location. While a person can manage some burns at home, more severe burns require immediate medical treatment.

First-degree burn treatment

These are generally not severe and most clear up relatively quickly. However, first-degree burns can be painful. The American Academy of Dermatology (AAD) has a video that provides guidance on treating first-degree burns.

Here is a quick guide:

• hold under cool water or apply a cool compress for 5-10 minutes or until the pain subsides
• cover burn with a non-stick, sterile bandage
• clean wound gently with lukewarm water
• apply petroleum jelly daily
• over-the-counter (OTC) medication such as ibuprofen can help with pain and reduce inflammation

Click here to learn more about sunburn treatment.

Remember, if the burn is substantial or the person is an infant or older adult, seek medical attention.

Learn about home remedies for mild burns here.

Second-degree burn treatment

Treating these types of burns will depend on its scale and location. Hot water and objects, radiation, friction, electricity, or chemicals can cause second-degree burns.

Symptoms include the skin blanching when pressed, blistering, and swelling. These burns calm down within a couple of days.

Home treatments include:

• running the burn under cool water to ease the pain — do not use ice as it can cause tissue damage
• removing jewelry, rings, or clothing that could become too tight around the swelling
• applying a cool compress if the burn is on the face or body
• cleaning and washing the burn gently — always wash the hands first
• wrapping loosely with a bandage if clothing or dirt is likely to cause irritation
• moisturizing lotion can help, but follow instructions closely
• applying over-the-counter antibiotic ointment
• talking pain relievers, such as ibuprofen or acetaminophen

Hot oil, grease, or microwaved liquids can cause deeper partial-thickness burns. Symptoms can take a few days to develop, so monitoring the wound is crucial to prevent infection.

People with a more severe second-degree burn should see a healthcare professional for treatment. They may prescribe a course of antibiotics or ointment. In extreme situations, a person may require a skin graft.

Third-degree burn treatment

This is the most severe burn and always requires medical treatment. Because a third-degree burn often destroys nerve endings, a person may not feel any pain when they touch the area. The skin can become raised, leathery, and dark brown, or waxy and pale.

Keep a person who has sustained third-degree burns warm and still. Complications may include:

• infections
• blood loss
• tetanus
• shock
• hypothermia

Severe burns covering a large part of the body may require intravenous antibiotics and skin grafts. Recovery times vary and depend on the location of the burn.

A person may require treatment If blisters burst on a mild-first degree burn, such as on a hand or sunburn.

If the burn is more severe, and pain does not settle after a couple of days, a doctor can prescribe antibiotics and recommend further treatment. This includes a specialist burn care service.

Chemical burns are the result of exposure to acids, oxidants, bleaches, and gasses. They commonly occur in children.

Third-degree burns are serious and often leave visible scarring. Children and the elderly are most at risk. After car accidents and drowning, burns are the most frequent cause of childhood death.

While mild burns are common household injuries and may be very painful, it is possible to treat them at home. However, more severe burns require an expert opinion.

To avoid sunburn, wear sunscreen and a hat. If there are hot appliances in a kitchen, take great care, and use protective gloves around an oven or stove.