What to know about third degree burns

Third degree burns are a severe type of burn that extends through every layer of skin. This type of burn can destroy:

• the epidermis, the outer layer of skin
• the dermis, the layer beneath the epidermis
• the hypodermis in some cases, which is the subcutaneous tissue and the innermost layer of skin

Doctors categorize burns according to the damage they cause to the skin and surrounding tissue. Types of burns include:

• First degree burn: Also known as superficial burns, these are the most common type. This burn damages the outermost layer of skin and typically heals on its own within 1 week. A common example is sunburn.
• Second degree burn: Also known as partial-thickness burns, this type damages the top two layers of skin. Second degree burns may require a graft and typically leave scars.
• Third degree burn: These burns completely damage the skin, including hair follicles and sweat glands. They may also damage the underlying tissue and always require a skin graft.
• Fourth degree burn: This type of burn extends into fat.
• Fifth degree burn: This burn type extends into muscle.
• Sixth degree burn: This type of burn extends to the bone.

Third degree burns will typically result from contact or exposure to the following:

• flames
• flash from an explosive blast
• chemicals such as acids
• electricity
• scalding liquids
• contact with an extremely hot object for an extended period

Any severe burn will typically be apparent and will require treatment at the hospital.

Common symptoms

Common symptoms of full-thickness burns may lead to:

• skin discoloration, which can include the skin becoming:
  • white
  • grey
  • black
  • brown
  • yellow
• skin appearing
  • dry
  • leathery
  • waxy
• swelling
• a lack of pain due to damage to nerve endings

Shock

Severe burns can also result in potentially fatal complications. For example, the body may go into shock.

Normally, the body produces an inflammatory response to protect itself from injury, infection, or other threats. However, in some cases, such as with severe burns, the body may overreact, and the inflammatory response may cause more harm.

Shock typically causes damage because the extreme inflammatory response results in tissues and organs not receiving enough oxygen. Several organs, such as the lungs, heart, and brain, are particularly susceptible to damage by “burn shock.”

Infections

Infection is another major concern with third degree burns. The severe damage to the skin makes the body more susceptible to pathogens.

Burns can also weaken the immune system, meaning the body is less capable of fighting off infection. In particular, acquiring pneumonia and sepsis infections are common and potentially fatal complications.

A doctor can usually diagnose the severity of a burn by examining the affected area. They may also ask questions about the cause of the burn, any other injuries, and whether the person has any other medical conditions.

The doctor may determine the severity of the burn by accounting for:

• the patient’s age
• the percentage of total body surface area burned (TBSA) using the rule of nines
• the type of burn
• which body parts are involved

A doctor may classify a severe burn under the following criteria:

• more than 10% TBSA in children or older adults
• more than 20% TBSA in adults
• more than 5% third degree
• significant burns to the:
  • face
  • eyes
  • ears
  • joints
  • genitalia

According to the World Health Organization (WHO), any third degree burn requires immediate hospitalization and treatment. Individuals with this type of burn usually receive treatment at a special burn unit.

Following a third degree burn, people should immediately try to arrange medical assistance.

While waiting for emergency care, a person can ensure an individual with a third degree burn:

• is out of harm’s way
• is breathing
• has restrictive items and clothing near, but not on, the wound removed

People can also cover the area with a sterile bandage, attempt to separate fingers and toes if burned, and, if possible, elevate the burned area above the heart.

The treatment a person receives will depend on the extent, severity, and location of the burn. The cause of the burn and a person’s health will also determine which treatment they receive.

Treatment for third degree burns may include:

• Surgery: Third degree burns typically require multiple surgeries to remove burned tissue from the burn site.
• Skin graft: As third degree burns do not heal by themselves, a skin graft is often necessary. A doctor may use a combination of natural skin grafts, artificial skin products, or laboratory-grown skin.
• Intravenous fluids: Some people may receive extra fluids to maintain their blood pressure and prevent shock.
• Medication: A person will likely receive several different medications, such as antibiotics and pain medication, to prevent infection and ease pain.
• Tetanus shot: As tetanus bacteria are more likely to trigger infections through burn wounds, a person may receive a tetanus shot to prevent this.

Third degree burns are serious and require immediate medical attention. Without treatment, they can be fatal. The WHO estimate that burns cause roughly 180,000 deaths every year, while non-fatal burn injuries are a leading cause of morbidity.

Children and older adults are particularly at risk. Research suggests that after car accidents and drowning, burns are the most frequent cause of childhood death.

The American Burn Association provide resources allowing people to search for their nearest burn center in the United States.

Treatment for third degree burns continues after a person leaves the hospital. While the recovery period differs for everyone, people commonly report feeling pain, fatigue, and itching.

People will still require wound care, which involves cleansing and dressing the wounds. This may require a nurse or doctor, or for the person with burns to learn how to clean and dress wounds. A friend or family member could also assist.

Individuals may require rehabilitation and counseling to help with their ability to perform daily tasks, with any potential issues communicating, and improve their mental health.

The healing time of a burn injury depends on the:

• burn extent
• burn depth
• location of the burn
• person’s age
• presence of other injuries or conditions

Due to medical advances, people are now capable of recovering from burn injuries that were previously fatal. However, individuals will often have permanent impairments and scarring.

Third degree burns are deep, severe burns that completely damage the skin. Causes can include exposure to flames, explosions, or strong chemicals.

People with third degree burns need immediate medical attention from a special burn unit. This can help prevent serious complications such as infection or shock.