Types of burns and the burn healing process

A first-degree burn, sometimes called a superficial burn, is the mildest type of burn. This type of burn only damages the top layer of skin (epidermis).

A superficial burn is usually red or cherry red. Pain and swelling of the burn injury is mild and will start to lessen after one or two days. You may notice the skin over your burn peeling after a couple days. First-degree burns don’t cause blisters.

In most cases, first-degree burns don’t require medical attention. However, some burns might be deeper than they look on the surface.

We recommend speaking to a doctor if you have questions about a burn, if you have a first-degree burn over a large part of your body or if your burn is causing extreme pain.

Second-degree burns, also called partial-thickness burns, are more severe than first-degree burns. When you have a second-degree burn, the top layer of the skin and part of the second layer of the skin (dermis) are damaged.

Partial-thickness burns usually cause blisters, pain and swelling. Your skin may be a deep red or white color or look wet and shiny. These burns typically take 2-3 weeks to heal and may leave scars.

If you suspect that you have a second-degree burn, speak with a doctor. Sometimes, second-degree burns require medical attention in order to heal properly.

Second-degree burns are often broken down into two types, superficial partial-thickness burns and deep partial-thickness burns.

Superficial partial-thickness burns cause blistering and are painful. They typically heal within three weeks with minimal scarring.

Deep partial-thickness burns are dry and can look tan and leathery or pearly white. The appearance of deep partial-thickness burns varies depending on the color of your skin. They take longer to heal and usually produce some scarring. Skin grafts are usually recommended for these types of burns. If you think that you have deep partial-thickness burns, visit a doctor.

Third-degree burns, sometimes called full-thickness burns, are the most severe types of burns. They destroy the first and second layers of skin. Third-degree burns might also damage the tissue, muscle and bone under the skin.

Third-degree burns often look dry with a dark brown or black color, but the color of third-degree burns varies depending on your skin tone. Your skin may have a leathery texture. In some cases, third-degree burns cause extreme pain, but damage to the nerves may mean that your injury feels painless or numb.

Full-thickness burns won’t heal on their own and require medical attention. Visit the Regions Hospital Burn Center immediately if you think you or someone you love has a third-degree burn.

Most full thickness burns are best treated with early removal of the dead tissue, skin grafting and long-term use of compression therapy to minimize scarring.

Thermal burns are the most common. These are burns caused by flames, hot liquids, steams or touching a hot surface. Sunburns are also very common. Most burns are minor, first-degree burns that will heal on their own. More severe burns need treatment from a doctor in order to heal.

The symptoms of burns include:

• Pain on the injured area
• Blisters or peeling skin
• Skin that feels warm to the touch
• Itchy skin
• Change of skin color on the affected area (pink, red, white, gray or black)
• Numbness
• Scarring
• Splotchy skin

Burns take 1-3 years to heal if scar tissue develops. The use of pressure garments and plastic orthoses (braces) may shorten the healing time.

If thick scars don’t form over the burn, healing is complete when the color of the wound returns to normal. This usually takes 6-12 months. Burns, graft sites and donor sites that have finished healing are called mature wounds.

A mature burn wound is when the skin feels soft and supple again. A mature burn also changes color, its color will fade to a more normal skin color as it heals. The length of time it takes for burns to mature varies from person to person. In general, the healing process takes between one and three years.

Burns are painful, and we do our best to help you feel as comfortable as possible. We use a combination of medicines to keep your pain at a tolerable level.

We’ll also teach you relaxation techniques to use in addition to the pain relief medicines. While we don’t have a magic remedy that can relieve all the pain caused by burns, we’ll use our best efforts to keep pain at a tolerable level.

Many burn survivors experience an itching, tingling feeling while they’re healing. The itchy feeling may be caused by nerves regrowing under the damaged skin. Or it may be because the oil glands under the skin were damaged or destroyed by the burn. The lack of natural oil production can cause itchy, dry skin.

As the skin heals after a burn, it’s common for the wound to feel itchy. Here are some things that can help:

• Apply lotion 4-6 times each day
• Wear tight pressure garments
• Avoid alcohol or activities which make you perspire
• Ask your doctor for anti-itch medicine or other treatments that may help with itching

When a burn starts to heal, the healed outer skin layer (epidermis) isn’t tightly attached to the deeper layers of the skin. Newly healed skin is very fragile – open areas, tears and blisters are a common problem.

It’s also common to lose small areas of a skin graft because of the buildup of fluid under the graft that occurs right after surgery. Grafted areas aren’t as thick as normal skin, which means they’re more susceptible to blisters and open areas.

There are many topical creams and wound dressings that can help treat open areas of your burn. In most cases, you and your doctor will find out what works best for you. We typically recommend:

• Xerform – a wound dressing that has Bismuth Tribromophenate.
• Unna zinc oxide impregnated bandages – bandages that have zinc oxide inside the gauze.
• Silver sulfadiazine (Silvadene® or SSD) – a mild antibiotic cream used specifically for moderate and severe burns.
• Bacitracin – a mild antibiotic ointment.

You can use these treatments alone or in combination on your open areas. If one treatment doesn’t work for you, try another one. We may also recommend using different wound dressings on a trial basis to see if they’ll help close the wound.

The amount of time your skin will be tight after a burn varies. Depending on your injury, skin tightening can go on for up to three years. As skin matures, it softens and feels less tight.

Skin tightness (also called contracture) that limits your range of motion can be permanent if the tight area isn’t stretched while the skin is healing and maturing. If a burn extends over a joint, it can be a challenge to maintain your range of motion and reduce tightness.

If you do have skin tightness, anti-contracture positioning is recommended 24 hours a day. In some cases, surgery may be necessary to relieve the contracted area. Contracture release surgery is most likely to be performed on joint areas, depending on where you were burned.

A burn that’s treated properly doesn’t increase your risk of skin cancer. If you have any concerns about your risk of developing skin cancer, talk to your burn doctor or nurse. We’ll answer all of your questions and talk with you about your risks.

We accept most health insurance plans, including Blue Cross and Blue Shield of Minnesota, CIGNA, HealthPartners, Medica, Medicare, PreferredOne and many others.

Not sure what your insurance covers? Call the number on the back of your card for help looking at your options.

Don’t have your card in front of you? Here are member services numbers to help you get started:

• HealthPartners: 800-883-2177
• Blue Cross and Blue Shield of Minnesota: 800-382-2000
• CIGNA: 800-244-6224 (insurance through work); 866-494-2111 (insurance directly or through the Exchange)
• Medica: 800-952-3455
• Medicare: 1-800-MEDICARE (1-800-633-4227)
• PreferredOne: 763-847-4477 (in the Twin Cities); 800-997-1750 (outside the metro area)
• United Healthcare: 877-842-3210