From the Guidelines
Second-degree burns are less severe than third-degree burns and can often be managed with proper care, but third-degree burns always require immediate medical attention due to the high risk of complications and scarring. When comparing second-degree and third-degree burns, it's essential to consider the severity and potential outcomes. Second-degree burns damage the epidermis and part of the dermis, causing redness, pain, swelling, and blisters, and typically heal within 2-3 weeks with proper care 1. In contrast, third-degree burns are more severe, destroying the entire epidermis and dermis, extending into deeper tissues, and always require immediate medical attention, often necessitating skin grafting, and will result in scarring.
Some key differences between second-degree and third-degree burns include:
- Appearance: Second-degree burns appear red and blistered, while third-degree burns appear white, charred, or leathery
- Pain: Second-degree burns are painful because nerve endings remain intact, while third-degree burns may be less painful because nerve endings are destroyed
- Healing time: Second-degree burns typically heal within 2-3 weeks, while third-degree burns often require longer periods of treatment and recovery
- Scarring: Second-degree burns may leave minimal scarring, while third-degree burns will always result in scarring
According to the American Burn Association, patients with second- or third-degree burns involving the face, hands, feet, and genitals and those involving >10% body surface area (5% in children) should be treated in a specialized burn center because of the likely need for intravenous fluid resuscitation, surgery, and other specialized treatments 1. Additionally, over-the-counter analgesics such as acetaminophen or NSAIDs are well tolerated and generally recommended for burn pain, and petrolatum, honey, and aloe have been shown to improve healing time in patients with partial-thickness burns 1.
From the FDA Drug Label
Silver sulfadiazine cream, USP 1% is a topical antimicrobial drug indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second and third degree burns. The drug silver sulfadiazine is indicated for both 2nd and 3rd degree burns for the prevention and treatment of wound sepsis, with no distinction in its use between the two 2.
From the Research
Burn Degrees and Treatment
- Second-degree burns are subdivided into two categories: superficial and deep, with superficial partial-thickness burns extending into the dermis and taking up to three weeks to heal, while deep partial-thickness burns require immediate referral to a burn surgeon for possible early tangential excision 3
- Third-degree burns, also known as full-thickness burns, involve the entire dermal layer and require automatic referral to a burn center 3
Comparison of 2nd and 3rd Degree Burns
- Second-degree burns may take up to three weeks to heal, while third-degree burns have a more severe and complex healing process 3
- Patients with third-degree burns are at a higher risk of complications and should be referred to a burn center immediately 3
Management and Treatment
- Initial treatment for burn injuries is directed at stopping the burn process, with subsequent treatment depending on the depth and severity of the burn 3
- Accurate assessment of burn depth and appropriate fluid management are essential in the early management of burn injuries 4
- Current practices in burn care have increased survivability even from massive burns, with recent advances focusing on acute respiratory distress syndrome, acute kidney injury, and transfusion 5