Assessment of burn degrees
Authors: Rami Mossad Ibrahim, MD, Elisabeth Lauritzen, MD, Frederik Gulmark Hansen med.stud., Magnus Balslev Avnstorp, MD and Rikke Holmgaard, Consultant, Burns Specialist, MD, PhD
Epidermal burns (1st degree)
Presents with a red skin burn. Cell destruction only extends only into the epidermis (1). A sunburn is a typical epidermal burn. The lesion presents itself as redness (erythema), but there are no bullae. The skin is red but intact. The epidermal burns do not require treatment beside sun cream and painkillers. 1st degree burns should not be taken into account when calculating the area of the burn (TBSA%) in regard to fluid resuscitation and hospital admission.
Dermal burns (2nd degree)
Presents with blisters/bullae filled with serous fluid, deep redness, pain, swelling and when the blisters are removed a shiny/wet surface. 2nd degree (dermal burns) are categorized into superficial burns and into deep burns including the more profound part of the dermis.
Superficial burns will remain a normal capillary response when pressure is applied (Becomes pale under pressure and red again when pressure is released).
Deeper burns will not have a normal capillary response (Will remain reddish when pressure is applied).
The sub-dermal parts of the skin with hair follicles, sebaceous- and sweat glands are intact in 2dn degree burns (Fig. 6) (1).
Swelling (oedema) occur approximately 15 min – 1 hour after the burn, reaching its maximum after approximately 24 hours.
If the dermal burn remains non-infected it heals conservatively. The superficial dermal burn will heal in 10-14 days, usually without scarring. The deep dermal burns heal after more than 3 weeks and can leave significant scarring.
Subdermal burns (3rd degree)
All dermal cells are affected, and the burn has reached the subcutaneous part of the skin (1). Only cells from connective tissue remain intact. A subdermal burn will therefore not heal conservatively from epithelial cells in woundbed. The lesion must either be excised and grafted or heal by shrinking and epithelial growth from the rim.
- Orgill DP, Solari MG, Barlow MS, O’Connor NE. A finite-element model predicts thermal damage in cutaneous contact burns. J Burn Care Rehabil [Internet]. [cited 2018 Mar 25];19(3):203–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9622462
Illustrations: Emma Tubæk, med.stud.