Burn Classification: Second-Degree Partial-Thickness Burn
A burn with blisters is classified as a second-degree partial-thickness burn, which involves injury extending into the dermal layer of the skin. 1, 2, 3
Understanding Burn Depth Classification
Burns are classified based on the depth of tissue injury:
- First-degree (superficial) burns involve only the epidermis, appear red without blisters, and cause pain 3, 4
- Second-degree (partial-thickness) burns extend into the dermis and characteristically form blisters, which is the defining feature of this burn depth 1, 2, 4
- Third-degree (full-thickness) burns destroy the entire dermal layer and appear white, charred, or leathery without blister formation 3, 4
Why Blisters Indicate Partial-Thickness Injury
Blister formation occurs specifically in second-degree burns because the injury extends deep enough into the dermis to cause separation between skin layers, allowing fluid accumulation, but does not completely destroy the dermal layer. 5, 6
- The blister fluid is an ultrafiltrate of plasma rich in proteins, immunoglobulins, cytokines, and interleukins 5
- The presence of intact blisters indicates that some viable dermal tissue remains, which is essential for healing potential 7, 6
Subcategories of Second-Degree Burns
Partial-thickness burns are further subdivided based on depth:
- Superficial partial-thickness burns extend into the superficial dermis, heal within 2-3 weeks, and typically do not require surgical intervention 3, 4
- Deep partial-thickness burns extend into the deeper dermis, may require surgical excision and grafting, and should be referred immediately to a burn surgeon 4
Clinical Significance for Management
The presence of blisters automatically places the burn in a category requiring more advanced wound care than simple first-aid measures. 2, 4
- Superficial first-degree burns without blisters can be managed with over-the-counter pain relievers and simple moisturizers 2, 4
- Any burn with blisters requires proper wound dressing, monitoring for infection, and consideration for specialist referral depending on location and extent 1, 2
- Burns with blisters involving the hands, feet, face, or genitals require specialized burn center evaluation regardless of size 1, 8, 2
Common Pitfall to Avoid
Do not assume all blistering burns are minor injuries—the location and total body surface area involved determine whether outpatient management is appropriate or immediate burn center referral is required. 1, 8, 2