Burn Classifications and Treatment: What UK Healthcare Professionals Should Know

Burns are a common injury seen in primary care, affecting patients of all ages. While most minor burns can be treated conservatively, it is essential to accurately assess the severity of a burn to ensure appropriate management and referrals. Burns are classified based on the depth of tissue damage into three categories: first-degree, second-degree, and third-degree burns. Understanding these classifications is vital for determining the appropriate treatment and for anticipating potential complications.

For more insights into wound care, you may find Practitioner Development UK’s The Three Different Phases of Wound Healing helpful.

First-Degree Burns: Superficial Burns

First-degree burns, also known as superficial burns, are the least severe. These burns affect only the outermost layer of skin, the epidermis. Sunburn is a common example of a first-degree burn. These burns typically present with redness, minor swelling, and pain but do not blister. The affected area is dry, and the skin remains intact.

Signs and Symptoms:

Redness and mild swelling

Pain or discomfort

No blistering

First-degree burns usually heal within 3 to 7 days without the need for medical intervention, and they rarely leave scars. Treatment typically includes cooling the burn with water, applying a soothing ointment like aloe vera, and providing pain relief with over-the-counter analgesics. It is important to educate patients on avoiding further sun or heat exposure to prevent worsening the injury.

Second-Degree Burns: Partial-Thickness Burns

Second-degree burns, or partial-thickness burns, affect both the epidermis and the underlying dermis. These burns are more serious than first-degree burns and are often accompanied by blistering, which differentiates them from superficial burns. The skin may appear red, moist, and swollen, and the blisters can either remain intact or rupture, leaving a weeping wound. Second-degree burns are typically more painful because nerve endings in the dermis are exposed or damaged.

Signs and Symptoms:

Red or splotchy appearance

Moist or weeping surface

Blistering

Significant pain

Second-degree burns require closer monitoring, as infection can occur if blisters rupture. These burns generally heal within 2 to 3 weeks, but larger burns may need referral to specialist care. Treatment focuses on wound care, including dressing the burn to keep it clean, providing analgesia, and monitoring for signs of infection.

Third-Degree Burns: Full-Thickness Burns

Third-degree burns, also known as full-thickness burns, are the most severe. These burns extend through the entire dermis and can even affect deeper tissues such as fat, muscle, or bone. Unlike first- and second-degree burns, third-degree burns may not be painful initially, as the nerve endings in the skin are destroyed. The skin may appear white, black, brown, or leathery, and there is no elasticity in the affected area.

Signs and Symptoms:

Charred or leathery appearance

White, black, or brown discolouration

Little or no pain due to nerve damage

Dry, non-blistering surface

Third-degree burns are a medical emergency and require immediate hospitalisation. These burns often necessitate surgical intervention, such as skin grafting, and may result in significant scarring or contractures. Because of the high risk of infection and fluid loss, fluid resuscitation, wound debridement, and infection control are critical aspects of treatment.

Conclusion

Burns can range from minor injuries requiring basic wound care to severe, life-threatening emergencies. Understanding the differences between first-, second-, and third-degree burns is essential for primary care professionals to ensure proper diagnosis, treatment, and referral when necessary. Educating patients on burn prevention and first-aid measures can help reduce the incidence and severity of burns.

For more detailed information on wound care, read Practitioner Development UK’s article on The Three Different Phases of Wound Healing.

References:

Jeschke MG, Gauglitz GG. Advances in Burn Care and Treatment. Lancet. 2019; 393(10190):2428-2442.

Kearns RD, Holmes IV JH. Burn Wound Healing and Treatment. British Journal of Healthcare Management. 2020; 26(1):32-39.