At Burn and Reconstructive Centers of America (BRCA), our national burn care specialists treat the continuum of burn injuries. From the expertise of critical care and pediatric intensivists to the consultation of staff psychiatrists, we truly treat the entire patient. BRCA’s burn care services include thermal burns, electrical burns, friction burns/road rash, frostbite, radiation burns and inhalation injuries.
Are all burn injuries the same?
While the mechanisms (scald, candle wax, battery acid, etc.) of a burn may vary, the general classification of burn injuries remains the same. There are four degrees of burn severities ranging from mild to severe. These degrees are also sometimes referred to in different terms, such as:
- First-degree burn or superficial burn
- Second-degree burn or partial thickness burn
- Third-degree burn or full-thickness burn
These alternate terminologies are used to describe the depth of the burn injuries. Mild or first-degree burns are considered superficial burns because they only affect the top layer of skin known as the epidermis, while second-degree burns are more profound, affecting the top and second layer of skin (the dermis). A third-degree burn affects all layers of skin as well as the underlying tissue and fascia, making it a full-thickness burn.
What does “full-thickness burn wound” mean?
A full-thickness burn, also known as a third-degree burn, is a severe burn injury that affects both layers of skin, underlying fatty tissue, nerves and tendons. These burn wounds are considered medical emergencies and typically will not heal without medical intervention. They are known to affect the nerves and are noticeably less painful or painless compared to first and second-degree burns.
What are the characteristics of a full-thickness burn?
Often, you can tell the burn wound’s severity by the injury’s characteristics. While these characteristics are a good guide to navigating your response, you should never self-diagnose a burn wound without following up with a doctor or burn specialist. Less severe burns include first and second degree.
First-degree (superficial) burn: This mild burn appears dry, red and swollen, affecting only the top layer of skin (epidermis). Common first-degree burns include sunburns and brief contact burns.
Second-degree (partial thickness) burns: This moderate burn appears red, wet, swollen and possibly blistering. This severity is painful and affects both the top and second layers of skin. Common causes of second-degree burns include severe sunburns, scald burns and contact burns.
Third-degree is synonymous with full-thickness burns: This burn severity is noticeably pain-free. The area will appear dry and tight and be devoid of capillary refill (white). Instead of blistering, you may notice skin peeling or skin sloughing. Common causes of third-degree burns include vehicle exhaust burns, friction burns, burns by fire and more.
Another degree of burn—the fourth degree—is the most severe in the burn classification. Fourth-degree burns involve the skin, tissue, nerves, tendons, muscles and sometimes bone. Fourth-degree burns are considered medical emergencies.
What is the outlook for a full-thickness burn?
Burn injuries can range from mild to life-threatening depending on the mechanism and severity. The short-term and long-term outlooks can depend on factors such as age, pre-existing conditions, infection, total body surface area (TBSA) burned, etc.
First-degree (superficial) burns: These burn injuries typically last three to five days and heal without medical intervention. Redness, pain, itching and peeling are common symptoms of this degree of burn. Affected areas will heal without scarring.
Second-degree (partial thickness) burns: A more severe burn; this degree of burn can last for up to three weeks. Peeling and blistering are common symptoms of this moderately severe burn. Depending on the size of the area and whether the burn progresses into a third-degree burn, medical intervention may be necessary. Often, a second-degree burn smaller than the size of the palm of your hand will heal in a week or two. Affected areas may be at risk of healing with mild scarring.
Third-degree (full thickness) burns: These burns can last months and require medical intervention to help heal. Extreme blistering, discoloration and skin sloughing or shedding are common symptoms of third-degree burns, though fever is also possible. Affected areas will likely scar or suffer other complications during the healing process. Over vital areas such as eyes, hands feet, these burns will most likely require operative intervention for repair, regardless of the size of the burn. And, burns larger than the size of a coin would benefit from operative intervention.
Fourth-degree burn: The outcome of fourth-degree burns can vary. Often, when treating patients with this burn, the burn specialist’s top priority is restoring blood flow to the peripheral areas to avoid as much tissue death as possible. Severe scarring is likely, and amputation is possible.
When should I call a doctor?
All third-degree or full-thickness burns are considered medical emergencies. If a suspected third-degree burn has been suffered, seek a doctor or burn specialist immediately, as the area will likely need skin grafts to heal. Other reasons to consult a medical professional include:
- A second-degree burn on an area larger than the palm of your hand
- A burn on an area that might reduce function (hands, fingers, feet, toes, major joints)
- A burn on your face or genitalia
- A burn to the eyes or airways
- A large blister or multiple blisters
- A blister that does not heal within a week. This may indicate a chronic or non-healing wound
- A blister that interferes with functionality (on the feet or hands)
Monitor the affected area for signs of infection. Infected burns significantly increase the risk of complications and life-threatening conditions. Signs and symptoms of burn and wound infection include:
- Abnormal drainage
- A change in skin or tissue color
- Foul odor
- Fever
- Pain in the wound and surrounding areas
- Pain in areas away from the wound
- A blister that appears filled with pus (cloudy and firm)
If you experience any of the above, call your doctor or BRCA’s burn information services at (855) 863-9595 for a consultation or to speak with a provider.
Further Information
An infected burn wound or burn blister can cause serious health problems and treatment complications if not identified and diagnosed early. It is uncommon for a first-degree burn to become infected. However, an infected second-degree burn is not uncommon. The more severe the burn damage or the more significant the burn wound, the more likely infection is to set in.
If you feel your burn wound is infected, the best action is to contact your provider or call our 24/7 burn information service at (855) 863-9595. Treating the infection as early as possible is best to prevent further complications. Leaving an infection untreated may lead to graft loss, tissue death, amputation, full-body infection and more.
For more information on thermal burns, please click here.
For more information on burn infections, please click here.
For information on how to cover a burn wound, please click here.
For information on vehicle exhaust burns, please click here.
For information on burn ointments and creams, please click here.
Please see the links below for patient stories on full-thickness burns:
Scotti Roberts: Burn survivor, peer supporter, LPN and future RN
The keys to success: pianist learns to play again after near hand amputation
Christian Cooper: Burn survivor, peer supporter, patient experience educator
