Burns are classified by severity as first, second, or third degree. First degree burns are the least severe, affecting only the outer layer of skin. Second degree burns go deeper into the skin, causing blistering. Third degree burns are the most severe, destroying both the outer and inner layers of skin.
What is a 1st degree burn?
A first degree burn, also called a superficial burn, only affects the outer layer of skin, called the epidermis. The burned skin is usually red, painful, and dry.
Some characteristics of a first degree burn include:
- Red, inflamed skin
- Pain and itching sensation
- Swollen, taut skin
- No blistering of the skin
While 1st degree burns are uncomfortable, they are generally minor and heal within 5-6 days. They usually do not require medical attention unless over a large area of the body. Proper care involves gently washing with mild soap, applying a cool compress, using a moisturizing lotion, and taking over-the-counter pain relievers as needed. While scarring is rare, the affected area may remain reddened for several months after healing.
What is a 2nd degree burn?
A second degree burn goes deeper into the skin, injuring both the outer epidermis layer and the inner dermis layer. This causes skin blistering from fluid buildup between these layers.
Characteristics of a 2nd degree burn are:
- Deep reddening and inflammation of the skin
- Blistering of the skin
- Severe localized pain and swelling
- Weeping clear fluid from blisters
Second degree burns can take 2-3 weeks to heal. Proper treatment involves gently washing, applying antibiotic cream, loosely bandaging, and managing pain. Blisters should never be broken, as this increases chances of infection. Depending on size and severity, some second degree burns may require a tetanus shot or hospital care such as IV fluids and antibiotics. Scarring often occurs after healing.
What is a 3rd degree burn?
The most severe burn classification, third degree burns go through the full thickness of the skin, causing widespread injury to nerves and tissues. With third degree burns:
- All layers of skin are damaged, as well as tissues below
- Skin may appear leathery or charred
- There is an absence of pain due to nerve damage
- Blood flow and oxygen delivery are impaired
- Risk of infection is very high
Third degree burns require emergency medical care and hospitalization. Treatment involves IV fluids, antibiotics, wound care, skin grafts, and long-term rehab. Healing can take months, along with the need for physical therapy to improve functionality. Due to extensive scarring, the skin texture is permanently damaged and discolored.
Comparing Severity and Symptoms
While all burns damage skin to some degree, the depth of injury increases from first to third degree. Here is a comparison of symptoms at a glance:
|Burn Degree||Skin Layers Affected||Appearance||Sensation||Healing Time|
|1st Degree||Outer layer (epidermis)||Reddened||Painful||5-6 days|
|2nd Degree||Outer and inner layers (epidermis and dermis)||Blistering||Very painful||2-3 weeks|
|3rd Degree||Full thickness of skin and underlying tissues||Leathery, charred, or pale||Painless from nerve damage||Months|
As this table shows, deeper burns progressively damage more layers and systems of the body, require longer healing times, and are more likely to result in scarring or complications.
Which Burn is Typically More Painful?
First and second degree burns are extremely painful. This is because the nerve endings in the outer and inner layers of skin remain intact and exposed. Third degree burns can actually be less painful in the initial aftermath because the severe damage destroys pain receptors in the skin.
However, third degree burns frequently require skin grafts and surgical debridement, which are very painful procedures. Overall, the longer healing time and need for regular wound care and daily re-bandaging of deep burns results in more pain over time.
Risk of Infection
Another factor making third degree burns the most dangerous is the greatly elevated risk of infection. With protective layers of skin compromised, bacteria and other pathogens can easily invade tissues and the bloodstream. Infection risks include:
- Necrotizing fasciitis
- Toxic shock syndrome
Serious infections can become life-threatening and require powerful antibiotics, surgery to remove dead tissue, or amputation. Second degree burns also carry infection risks if blisters break and expose dermal tissues. First degree burns have the lowest infection risk if properly cared for.
Scarring is common with third degree burns because the damaged skin cannot regenerate or heal itself. To close wounds, extensive grafting is required which results in thick, ropy scars with impaired sensation and movement. Hypertrophic scars may also form with raised, red tissue growing excessively.
Second degree burns frequently scar as well since they penetrate deeply into the dermis, but scars may be smoother and more pliable. First degree burns can minimize scarring if they heal quickly and do not injure the dermal layer.
Likelihood of Permanent Damage
Full thickness third degree burns pose the greatest risk of permanent damage to the body. Dense scarring can restrict movement of joints like the neck, elbows, or knees. Nerves may be too damaged to ever properly regenerate. Within the first few days, burn shock and inadequate blood and oxygen circulation can lead to organ failure.
With fast expert care, these outcomes can often be prevented. But third degree burns have the highest rates of long-term impairment. Second degree burns can also permanently damage sweat glands and hair follicles. First degree burns rarely cause permanent issues if minor in scope.
Healing times increase with burn degree:
- First degree: 5-10 days
- Second degree: 2-3 weeks
- Third degree: Several months to years
The more layers and systems impacted, the longer recovery takes. Third degree burns require initial emergency care and stabilization, followed by extensive hospital treatment and rehabilitation. Second degree burns take weeks to re-epithelialize the damaged dermis. First degree burns heal quickly with proper topical treatment.
Impact on Daily Living
Severe burns inevitably cause temporary disability and impact normal activities. But only third degree burns carry the risk of permanent impediments to activities like working, exercising, personal care, and using one’s hands.
Second degree burns may leave people unable to use affected limbs or perform physical tasks during the healing period. First degree burns have negligible impact on daily tasks, as long as kept clean.
All burns can cause psychological struggles with self-esteem, body image, anxiety, and post-traumatic stress. But the severity and visibility of scars from third degree burns is uniquely challenging for most patients.
Coping with extensive injuries, changed physical appearance, loss of function, and prolonged recovery time requires significant mental health support. Mild first degree burns have fewer lasting psychological impacts once healed.
While any burn can potentially be fatal, the risk of death directly correlates with degree. Most burn-related deaths occur from infections and sepsis arising in third degree burns. Additional mortality factors include:
- Burns over large surface areas of the body
- Inadequate fluid resuscitation
- Lung damage from inhaling smoke or heat
- Multiple organ failure
Second degree and first degree burns very rarely lead to death or life-threatening complications, unless very widespread over the body.
Treatment is customized to burn type and severity:
- 1st Degree: Topical antibiotics, aloe vera, moisturizers, OTC pain relievers
- 2nd Degree: Wound cleaning, topical antibiotics, burn dressings, pain medication, tetanus shot
- 3rd Degree: Emergency medical care, IV fluids, antibiotics, skin grafts, reconstructive surgery, physical rehabilitation
Only third degree burns require hospitalization and months of inpatient and outpatient treatments. Second degree burns may need medical visits but not hospital stays. First degree can be self-treated with OTC remedies.
Cost of Treatment
Burn treatment costs grow exponentially with severity due to extended hospital and rehab care. A 2020 study found average costs for acute burn care were:
- 1st Degree: $500-$1500
- 2nd Degree: $5000-$15,000
- 3rd Degree: $80,000-$350,000+
Insurance coverage and other factors affect costs. But third degree burns require hundreds of thousands in specialized medical care over years. Second degree burns cost several thousand dollars for expert wound care and recovery aids. Mild first degree burns have minimal costs with home treatment.
When comparing first, second, and third degree burns, third degree burns are unequivocally the most severe and dangerous. They damage the entire skin and underlying tissues, carry life-threatening complications, cause permanent impairments, and require months to years of treatments.
Second degree burns, while very painful and prone to scarring, do not impact as many body systems. With proper medical care, most recover without permanent damage. First degree burns are a mild skin injury that heals quickly with minimal intervention.
While all burns should receive appropriate care based on diagnosis, the depth of tissue damage and risk of infections, chronic issues, or death directly corresponds with burn degree. Therefore, third degree burns are overall the most traumatic, dangerous, and difficult to recover from.