Burns, Superficial Partial-Thickness (Second-Degree)
Section editor:
Superficial partial-thickness burns, traditionally referred to as second-degree burns, involve injury to the epidermis and the superficial (papillary) dermis. These burns are characterized by erythema, blister formation, and significant pain.
Characteristics
Thickness and depth. Second-degree burns extend beyond the epidermis into the dermis.1,2 These are subdivided into superficial partial-thickness burns, involving the papillary dermis; and deep partial-thickness burns, extending into the reticular dermis.
Appearance. Superficial partial-thickness burns present with redness with clear blisters, which blanch with pressure.1,2
Sensation. These burns are very painful due to exposed nerve endings.1,2
Texture. Moist and weeping.1,2
Healing and prognosis. These burns typically heal within 2 to 3 weeks with minimal scarring.1,2
Rule of Nines
Another contributing factor to burn severity is how much of the body is affected. The "rule of nines" is a method of approximation used to determine what percentage of the body is burned.3 Partial- or full-thickness burns on more than 15% of the body require immediate professional medical attention. Use the following approximations for adults:
• Head (front and back) ~ 9%
• Front of the torso ~ 18%
• Back of the torso ~ 18%
• Each leg (front and back) ~ 18%
• Each arm (front and back) ~ 9%
• Genitals/perineum ~ 1%
Additionally, the size of the patient’s palm (including the fingers) is approximately 1% of the total surface area of the body, and can be used to approximate noncontiguous burn areas.4
Risk Factors
Several factors increase the likelihood of sustaining superficial partial-thickness burns, and are similar to risk factors for burns in general:
Age. Young children and older adults are at increased risk due to thinner skin and reduced reaction times.5
Occupational hazards. Jobs involving exposure to hot substances, open flames, or chemicals elevate the risk of burns.5
Environmental factors. High ambient temperatures, inadequate protective measures, and unsafe cooking practices contribute to burn incidents.5
Medical conditions. Individuals with sensory impairments or mobility limitations may be more susceptible to accidental burns.5
Etiology
Superficial burns result from various external factors:
Thermal. Caused by fire, hot objects, steam or hot liquids (scalding).3
Electrical. Caused by contact with electrical sources or, in much more rare circumstances, by lightning strike.3
Chemical. Caused by contact with highly acidic or basic substances.3
Friction. Caused by friction between the skin and hard surfaces, such as roads, carpets or floors.3
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.3
Treatment
Management of superficial partial-thickness burns focuses on symptom relief, infection prevention, and promoting healing:
Gently cool the burn with cool (not cold) water for about 10 minutes to alleviate pain and limit tissue damage.6 Clean the area with mild soap and water to prevent infection.
Small blisters should remain intact to serve as a natural barrier against infection.6 Apply a sterile, non-adherent dressing to protect the wound and maintain a moist environment conducive to healing.
Administer over-the-counter analgesics like acetaminophen or ibuprofen to manage pain. Ensure tetanus immunization is up to date, especially if the burn is associated with an open wound.
Refer the following patients to a higher level of care for burns: patients with partial thickness (second degree) burns greater than 10% of the total body surface area; those with burns of the face, hands, feet, genitals, perineum, or across major joints; and those with full thickness (third degree) burns of any size.2,7
Complications
While superficial partial-thickness burns typically heal without significant issues, potential complications include:
Infection. Disruption of the skin barrier increases the risk of bacterial invasion, potentially leading to cellulitis or sepsis.3
Scarring. Although minimal, some scarring or pigment changes may occur, especially if the wound becomes infected.3
Pain. Persistent discomfort may require ongoing analgesia or evaluation for secondary complications.3
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. Żwierełło W, Piorun K, Skórka-Majewicz M, Maruszewska A, Antoniewski J, Gutowska I. Burns: classification, pathophysiology, and treatment: a review. Int J Mol Sci. 2023;24(4):3749. Published 2023 Feb 13. doi:10.3390/ijms24043749
4. American Burn Association. Advanced Burn Life Support Instructor Manual. Available at https://ameriburn.org/wp-content/uploads/2018/03/abls-instructor-qualif…. Accessed May 1, 2025.
5. World Health Organization. Burns. Available at https://www.who.int/news-room/fact-sheets/detail/burns. Published Oct. 13, 2023. Accessed March 21, 2025.
6. 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.
7. ISBI Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee. ISBI Practice Guidelines for Burn Care. Burns. 2016;42(5):953-1021. doi:10.1016/j.burns.2016.05.013
