What stage of burn is characterized by the presence of a blister?

Burn Classification: Blisters Indicate Second-Degree Burns

The presence of a blister indicates a second-degree or partial-thickness burn, which involves damage to both the epidermis and part of the dermis. 1

Characteristics of Second-Degree Burns with Blisters

• Pathophysiology: Second-degree burns damage both the epidermis and portions of the dermis, causing fluid to accumulate between tissue layers, forming blisters 1
• Appearance: Characterized by:
  • Blisters filled with clear fluid (blister fluid is an ultrafiltrate of plasma containing proteins, immunoglobulins, cytokines, and interleukins) 2
  • Moist, red, and painful wound bed if blisters rupture
  • Blanching with pressure
  • Heightened sensitivity to touch and temperature

Management of Burn Blisters

Blister Care

• Leave blisters intact whenever possible to:
  • Improve healing outcomes
  • Reduce pain
  • Provide a natural biological dressing
  • Prevent excessive water loss and dehydration 3, 1
• Protect intact blisters with a loose sterile dressing to prevent accidental rupture 4
• If blister ruptures or needs decompression:
  • Decompress by piercing and expressing fluid or aspiration 4
  • Keep the detached epidermis in place as a biological dressing 4
  • Apply a non-adherent dressing (such as Telfa™) to protect the area 4

Wound Care

• Cooling: Apply cool or cold potable water (15-25°C) for at least 10 minutes to relieve pain 4, 1
• Avoid:
  • Direct ice application (causes tissue ischemia) 4
  • Home remedies like butter, potato peels, or other non-medical treatments 1
• Dressing: After cooling, loosely cover with a sterile, dry dressing 4
• Antimicrobial considerations: Apply topical antimicrobial agents only to sloughy areas, not intact blisters 4

When to Seek Medical Attention

Medical evaluation is necessary for burns with blisters that:

• Cover more than 10% total body surface area (TBSA) in children or 20% in adults 1
• Involve the face, hands, feet, or genitals 4, 1
• Show signs of infection (increased redness, warmth, swelling, discharge, or fever) 1
• Are circumferential (encircling a limb) 1
• Are associated with difficulty breathing 4
• Cause significant pain not relieved by over-the-counter pain medications 1

Complications to Monitor

• Infection: The most significant risk for burn patients who survive initial injury 5
• Dehydration: Especially with large surface area burns or if blisters are ruptured 3
• Scarring: More likely with deeper second-degree burns or infected wounds
• Compartment syndrome: Monitor distal circulation, sensation, and motor function in extremity burns 1

Key Takeaway

The presence of blisters is the hallmark feature of second-degree (partial-thickness) burns. These burns require careful management to promote healing, prevent infection, and minimize scarring. While minor second-degree burns can often be managed at home, larger burns or those in sensitive areas require prompt medical attention.