Burns, Superficial (First-Degree)

Superficial burns, traditionally known as first-degree burns, are injuries confined to the epidermis. These burns are characterized by erythema without blister formation and typically heal without scarring. 

Characteristics 

Thickness and depth. First-degree burns are superficial, affecting only the epidermis, the outermost skin layer.^1,2

Appearance. These burns usually present as erythema without blisters.^1,2 The burned area blanches under light pressure, indicating intact capillary refill. For patients with darker skin tones, they may present as an area of hyperpigmentation rather than redness.

Sensation. Painful and tender to touch.^1,2

Texture. Dry without moisture or blisters.^1,2

Healing and prognosis. First-degree burns typically heal within 5 to 10 days without scarring. An example is a mild sunburn.^1,2 

Risk Factors

Several factors predispose individuals to superficial burns:

Age. Young children and older adults are at increased risk due to thinner skin and reduced reaction times.³ 

Occupational hazards. Jobs involving exposure to hot substances, open flames, or chemicals elevate the risk of burns.³ 

Environmental factors. High ambient temperatures, inadequate protective measures, and unsafe cooking practices contribute to burn incidents.³ 

Medical conditions. Individuals with sensory impairments or mobility limitations may be more susceptible to accidental burns.³

Etiology

Superficial burns result from various external factors: 

Thermal. Caused by fire, hot objects, steam or hot liquids (scalding).⁴

Electrical. Caused by contact with electrical sources or, in much more rare circumstances, by lightning strike.⁴

Radiation. Caused by prolonged exposure to sources of UV radiation such as sunlight (sunburn), tanning booths, or sunlamps or by X-rays, radiation therapy or radioactive fallout.⁴

Chemical. Caused by contact with highly acidic or basic substances.⁴

Friction. Caused by friction between the skin and hard surfaces, such as roads, carpets or floors.⁴ 

Treatment

Management of superficial burns focuses on symptom relief and promoting healing:

Stop the burning process by cooling the burn with running cool (not cold) water for at least 5 minutes.⁵ Patients should remove all jewelry, watches, rings, and clothing around the burned area as soon as possible.

Cover the burn with a sterile gauge bandage or clean cloth.⁵ Wrapping the burned area loosely avoids putting too much pressure on the burn tissue.

To relieve pain, administer an over-the-counter pain reliever such as ibuprofen or acetaminophen for pain control.⁵ Patients should seek medical attention if they have pain or a persistent fever not relieved by medication or if they have redness extending beyond the border of the burn. 
Minor burns will usually heal without further treatment.⁵

Complications

While superficial burns typically heal without significant issues, potential complications include:

Infection. Although rare in superficial burns, breaches in skin integrity can occasionally lead to bacterial entry. Burn sites can be susceptible to tetanus infections.⁴

Hyperpigmentation or hypopigmentation. Persistent changes in skin color may occur post-healing, especially in individuals with darker skin tones.⁶ 

Pain. Persistent discomfort may require ongoing analgesia or evaluation for secondary complications.⁵

References
1.    Warby R, Maani CV. Burn Classification. [Updated 2023 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539773/
2.    American Burn Association. Guidelines for Burn Patient Referral. Available at https://ameriburn.org/wp-content/uploads/2024/04/one-page-guidelines-fo…. Published 2022. Accessed March 21, 2025. 
3.    World Health Organization. Burns. Available at https://www.who.int/news-room/fact-sheets/detail/burns. Published Oct. 13, 2023. Accessed March 21, 2025. 
4.     Żwierełło W, Piorun K, Skórka-Majewicz M, Maruszewska A, Antoniewski J, Gutowska I. Burns: classification, pathophysiology, and teatment: a review. Int J Mol Sci. 2023;24(4):3749. Published 2023 Feb 13. doi:10.3390/ijms24043749
5.    American Burn Association. First aid for minor burns. Available at https://ameriburn.org/wp-content/uploads/2020/03/first-aid-fact-sheet.p… . Published 2020. Accessed March 21, 2025. 
6.    Zhong C, Liang G, Li P, et al. Inflammatory response: The target for treating hyperpigmentation during the repair of a burn wound. Front Immunol. 2023;14:1009137. Published 2023 Feb 1. doi:10.3389/fimmu.2023.1009137