Burn Types

SUPERFICIAL BURNS

(Also known as superficial first degree)

Only the upper strata of the epithelium are damaged. The key characteristics are:

The skin is intact but shows signs of redness and is very painful.
The skin also blanches under pressure. Minimal tissue damage occurs but may form blisters up to 48 hours after initial injury.
Heals well within 3-7 days with minimal or no treatment. No obvious scarring.

(Souter, 2010)

SUPERFICIAL DERMAL BURNS

(Also known as superficial partial thickness)

These burns extend beyond the epidermis into the top layer of the dermis. The key characteristics are:

Associated with blisters, red in areas, moist and exuding.
Brisk capillary refill, very painful.
Should heal within 10-21 days if no infection or pressure within or on the wound.
May appear red for the first six weeks.

(Souter, 2010)

Deep Dermal Burn

(Also known as deep partial thickness)

The burn extends into the deeper layers of the dermis and may involve the hair follicle or sweat glands.

The key characteristics are:

White/creamy in colour, large easily lifted blisters.
Slightly painful with areas that are insensate.
Will take more than 30 days to heal.
Preferable to skin graft early to maximise healing and minimise scar formation (Souter, 2010).
Healing associated with some contraction and scarring.

FULL-THICKNESS BURNS

(Also known as third-degree burns)

Full destruction of the epidermis and dermis. The damage may extend into the subcutaneous layer and may involve muscle and bone. Key characteristics are:

May appear waxy white, cherry red, grey or leathery in appearance.
Minimal or no pain in the wound. No response to temperature or pressure.
No capillary refill.
Require skin grafting as few regenerative elements in the skin to allow spontaneous healing.
Scar will be influenced by the grafting techniques.
Severe full-thickness burns (fourth degree) extend into muscle and bone.

It is often difficult to distinguish the exact depth of the burn. Many burns are mixed in depth. All patients should be reviewed between 48 and 72 hours after injury and follow ups continued until the wound is fully re-epithelialised (Souter, 2010).

Characteristics of Burn Types According to Depth

Classification	Depth of Injury	Appearance	Sensation	Most Common Cause of Injury
Superficial (first degree)	Epidermis	Intact skin Blanchable erythema and mild edema Brisk capillary refill No blisters	Tactile and pain sensations intact	Scalds from spilled liquids (low viscosity) Electrical flash Sunburn
Superficial partial-thickness (second degree)	Epidermis with partial-thickness loss of dermis Dermal appendages intact	Blanchable erythema Brisk capillary refill Intact or ruptured thin-walled serum-filled blisters (blisters may increase in size) If blisters ruptured, tissue is pink or red and moist.	Tactile and pain sensations intact	Scalds from spilled liquids (low viscosity) or steam Electrical flash Brief exposure to flame Brief contact with hot object Sunburn
Deep partial-thickness (deep second degree)	Epidermis with deep partial-thickness loss of dermis Underlying structures are not exposed Some dermal appendages intact	Non-blanchable erythema Sluggish capillary refill Intact or ruptured thick-walled serum-filled blisters (blisters may increase in size) If blisters ruptured, tissue is blotchy/mottled, cherry red/blanched white and dry	Deep pressure sensation intact Pinprick sensation absent Variable pain sensation	Scalds from spilled liquids (low and high viscosity) or steam Exposure to flame Contact with hot object
Full-thickness (third degree)	Full-thickness skin loss Underlying structures are not exposed Dermal appendages destroyed	Non-blanchable Capillary refill absent If present, blisters will be thin-walled and will not increase in size. Tissue leathery, pale, mottled and cherry red/brown in colour and dry Eschar may be present Thrombosed vessels visible Edema	Insensitive to pain and pressure	Scalds from liquid immersion Exposure to flame Prolonged contact with hot object Chemicals Electricity
Full-thickness (fourth degree)	Full-thickness skin and tissue loss Exposed or directly palpable underlying structures Dermal appendages destroyed	Non-blanchable Tissue leathery, pale, mottled, red/brown/white in colour and dry Eschar may be present Thrombosed vessels visible	Insensitive to pain and pressure	Prolonged liquid immersion scald Prolonged contact with hot flame, hot objects, or chemicals Electricity

Adapted from (Jeschke et al., 2018)

COMPLEX OR NON-COMPLEX BURNS

These categories take into account the degree of tissue damage and factors which will influence the care outcomes.

Complex

A burn is more likely to be complex if associated with the following:

Age under five or over 60 years
Dermal or full-thickness skin loss involving face, hands, perineum, feet and flexure such as the neck; circumferential dermal or full thickness burn of neck, torso, limb.
Inhalation injury
Chemical burn >5% TBSA, suspected non-accidental injury, high-voltage electrical injury, ionising radiation injury, high pressure steam injury, hydrofluoric acid >1% TBSA.

The burns size will affect complexity:

Over 16 (adult) >10% TBSA
Under 16 (paediatric) >5% TBSA

The presence of some coexisting conditions will also influence complexity:

Diabetes
Pregnancy
Hepatic disease cardiac disease or recent myocardial infarction
Immunosuppression
Respiratory disorder
As will the presence of injuries such as fractures, crush injury, head injury and penetrating injury.

(Vuolo, 2009)

All burns deemed to be complex should be referred to a Specialist Burns Centre

Non-complex

Size of burn

Over 16 years (adult) >5-10% TBSA if dermal, or smaller if full thickness
Under 16 years (paediatric) >2-5% TBSA if dermal or smaller if full thickness
Non-complex burns should be seen in a Burns unit or plastic surgery unit

(Vuolo, 2009)

Minor burns that don’t meet the above criteria may be seen in an A&E department or minor injuries unit.

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