First degree burns

Picture of first degree burn on hand

First degree burns

First degree burns (known in the UK as superficial burns), are amongst the most common types of burn. We discuss these burns and their treatment below. 

What is a first degree burn?

A first degree burn is a burn of the top layer of skin only. Of all burns that may need treatment, first degree burns are the most superficial.

How do people get first degree burns?

Probably the most common way to get a first degree burn injury is in the form of sunburn. Sunburn in the form of simple ‘redness’ does not count as a burn as such, but blistering sunburn is a form of first degree burn. 

In cooks and chefs, burns from hot liquids are also extremely common, and are known as ‘scalds’. A scald burn can occasionally be deep, but usually is first degree only. Burns from touching a hot oven can sometimes be first degree, but the surface is so hot that even a short contact can cause  deeper burn injury.

Any other cause of burns can also result in a first degree burn if the exposure is short – for example a flame injury will tend to only cause a first degree burn if the injury is a brief ‘flash’ of flame only (a common cause of this type of burn is if someone throws petrol or lighting fuel on a fire).

Does a first degree burn hurt?

Because a first degree burn affects the top layer of skin only, the nerve endings are still fully intact and so pain is felt – in fact the pain can often be pretty severe. This usually lasts for a few days, until the skin starts to heal itself. Simple painkillers or cold compresses can usually help with burn pain.

Are first degree burns dangerous?

Generally, most first degree burns are not life threatening, but some can be dangerous depending on the size of the burn. The size of the burn is worked out as a percentage of the ‘total body surface area’ (called ‘TBSA’ by burn specialists). As a rough guide, your palm and fingers are about 1% of your body surface area. In adults the head is about 9%, arms 9% each, legs 18%, back 18% and chest/abdomen 18%. The reason for being concerned about the size of the burn is that the higher the percentage of burn, the more serious it may be. Intravenous fluids (through a ‘drip’) are often given for burns larger than 10% in children and 15% in adults. 

Additionally, as the skin has been damaged in a first degree burn, bacteria can now enter into the skin and from there into the bloodstream – this can cause redness, swelling and infection of the burn, or septicaemia and life-threatening illness (known as toxic shock syndrome) if it progresses. 

First degree burn treatment

This depends on the TBSA (see above).  Larger first degree burns are given intravenous fluids (usually over 10% surface area burns in children or 15% in adults). Fluids may also be given to patients with other injuries sustained at the time of the burn, such as inhalation injuries, etc. A catheter may also be required so that urine production can be monitored, which informs the clinician of how well hydrated the patient is. 

Most first degree burns are treated simply with cleaning and dressings. These dressings may be simple non-stick dressings or ones which contain silver to fight bacteria, materials to promote healing etc. The dressings may need to be changed every 2-3 days until the burn has started to heal, which usually takes 1-2 weeks in a first degree burn.

Do first degree burns scar?

Not usually. Scarring from first degree burns is uncommon, but healing can be helped with treatments such as burn creams. Scars from burns are usually due to second or third degree burns.

What are the long-term problems of first degree burns?

Slow healing – first degree burns can occasionally take longer to heal than expected. This may be due to the patient themself being prone to poor healing (for example diabetics), or the wound being affected by factors such as infection or inappropriate treatment. 

Skin colour changes – whilst first degree burns usually heal with no noticeable skin changes, they can occasionally leave an area of pigment changes. This is usually in the form of a paler patch of skin, which can be permanent (known as hypopigmentation).

The list of consequences is not exhaustive, and you should discuss possible burn complications with your specialist. Whilst these risks will seem very worrysome, and indeed can be serious, it should also be borne in mind that many people have no problems whatsoever. 

The information provided is as a guide only and you should discuss matters fully with your specialist regarding any burn treatment required. Please also read our disclaimer

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