by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS
Health care professionals encounter burns in their patient populations frequently, and must be able to differentiate between types of burns, as well as know how to treat burn injuries using current practice standards. The following is an overview of first and second degree burns, including pathophysiology and treatment.
First Degree Burns
First degree burns, often referred to as superficial burns, affect only the epidermis or outermost layer of skin. They are dry, red and can be very painful. When touched, skin that is burned superficially will blanch. The injured epidermis will slough off after a few days. These burns generally heal quickly and do not cause scarring.
First degree burns are not considered to be open wounds; therefore, they require no dressings. Cool compresses may provide some relief from pain. In addition, moisturizers may increase comfort. Analgesics may be required for patients who experience large first degree burns. Some patients may even require hospitalization briefly in order to control pain. Antimicrobials are not required for first degree burns. Patients may be advised to apply a moisturizer containing a sun block to the burned area(s) until the burns have healed entirely.
Second Degree Burns
Second degree burns, also referred to as partial-thickness burns, are divided into two categories:
- Superficial partial-thickness burns - these burns involve the epidermis and the dermis. The dermis is only involved superficially. Second degree burns are moist and red. There may be blister formation. These burns are very painful due to the fact that nerve endings are intact but are exposed due to loss of the epidermis. Scarring may result, but is generally minimal. Superficial partial-thickness burns normally heal in approximately two weeks.
- Deep partial thickness burns - these burns involve the epidermis and extend through most of the dermis. They are less red and are drier than superficial second degree burns. They may also be less painful. These burns may take up to a month to heal, and scarring may be extensive.
It is important to remember that burns often contain a mixture of burn depths; therefore it is possible for a patient to have areas of both first and second degree burns.
There are two schools of thought in regards to how to treat blisters associated with second degree burns. Some experts favor leaving blisters intact, as they believe that blister formation protects the wound bed, keeping it moist, protected and clean, and that purposefully breaking or debriding blisters increases the risk of infection. Experts in favor of puncturing or debriding blisters believe that the fluid contained in blisters may provide a medium for bacterial growth, and that this fluid also inhibits immune function. There are valid arguments on both sides of the issue. Whether to leave blisters intact should be decided on an individual basis.
Dressing second degree burns should take into account keeping the wound bed moist and protected, as well as clean. In addition, patient comfort must be considered. The following are some points to keep in mind when considering dressing options for second degree burns:
- Avoid occlusive dressings, as they do not allow drainage of exudates and may provide an environment conducive to the development of infection.
- Silver sulfadiazine may be used for deep partial thickness burns. It is a broad spectrum antimicrobial. Do not use if the patient is allergic to sulfa drugs, is pregnant, or is an infant less than two months of age.
- Wrap fingers individually when dressing burn wounds to fingers.
- When dressing burns that are over a joint, be sure to allow full range of motion.
- Hydrofibers, alginates and foam dressings may be used on superficial partial thickness burns. These products may require fewer dressing changes. In addition, they absorb exudate and keep the wound bed moist.
- Bacitracin may be used on superficial partial thickness wounds. The ointment should be covered with a non-adherent dressing and dry gauze to secure it in place. Dressings may require changing twice a day, but should be changed once per day at a minimum.
- Burns should be cleansed initially with a commercial wound cleanser or a gentle soap and water.
It may be a simple matter to differentiate between first and second degree burns, but it is often more difficult to differentiate between superficial and deep partial-thickness burns. Deep second degree burns sometimes require grafting and a surgeon should be consulted if there is any doubt, particularly when burns are extensive.
Moss, L. (2010) Treatment of the burn patient in primary care. Advances in Skin and Wound Care 2010, 23: 517- 524.
Singer, A & Dagum, A. (2008). Current management of acute cutaneous wounds. N Engl J Med 2008; 359:1037-1046.
About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.