Identifying First-Degree and Second-Degree Burns
First-degree burns involve only the epidermis with intact skin that appears red and painful, while second-degree (partial-thickness) burns extend into the dermis and characteristically present with blisters, open wounds when blisters rupture, and more severe pain.
Clinical Characteristics to Distinguish Burn Depth
First-Degree Burns
- Skin appearance: Red, dry skin without blistering 1, 2
- Skin integrity: Completely intact epidermis with no breaks in the skin barrier 1
- Pain level: Painful but typically less severe than deeper burns 3
- Depth: Limited to the superficial epidermis only 3
- Healing: Self-limited with complete resolution and no scarring 3
Second-Degree Burns (Partial-Thickness)
- Skin appearance: Moist, weeping wounds with variable coloration from pink to red 1, 2
- Blister formation: Presence of fluid-filled blisters is the hallmark distinguishing feature 1, 2, 4
- When blisters rupture: Open wounds with exposed dermis and serous drainage 1
- Pain level: Extremely painful due to exposed nerve endings in the dermis 1
- Depth: Extends through epidermis into the dermal layer 5, 6
- Healing: Requires 2-3 weeks for superficial partial-thickness; deeper burns may require surgical intervention 5, 6
Immediate Management Based on Burn Classification
For First-Degree Burns
- Cool immediately with clean running water for 5-20 minutes 1
- Apply aqueous emulsions or petrolatum after cooling 2, 3
- Administer over-the-counter analgesics (acetaminophen or NSAIDs) 1, 2
- Cover with clean, non-adherent dressing if desired 1
- Can be managed at home without specialist referral 2, 4
For Second-Degree Burns
- Cool immediately with clean running water for 5-20 minutes, monitoring children for hypothermia 1
- Remove jewelry before swelling occurs 1
- Administer over-the-counter pain medications 1, 2
- Preserve intact blisters as biological dressings—do not rupture them 2, 7
- After cooling, apply petrolatum-based antibiotic ointment (bacitracin, neomycin, polymyxin B) to open wounds 1, 2
- Cover with clean, non-adherent dressing 1, 2
Critical Red Flags Requiring Immediate Specialist Referral
Second-degree burns involving the face, hands, feet, or genitals require specialized burn center care regardless of size 1, 2. The American Burn Association mandates burn center treatment for these anatomical locations due to high risk of permanent disability requiring surgical intervention 1.
Additional mandatory referral criteria include:
- Burns covering >10% body surface area in adults (>5% in children) 1
- Signs of inhalation injury: soot around nose/mouth, singed nasal hairs, difficulty breathing 1, 4
- Circumferential burns that may cause compartment syndrome 1
Common Pitfalls to Avoid
- Never apply ice directly to burns—this causes additional tissue damage through cold injury 1, 2, 7
- Never break intact blisters—they serve as sterile biological dressings that reduce infection risk and promote healing 2, 7
- Never apply butter, oils, or home remedies—these trap heat and increase infection risk 2, 4
- Never underestimate burn depth—when uncertain between first and second degree, treat as second-degree and seek evaluation 1