Second degree burns
Second degree burns (known in the UK as partial thickness burns), are ‘intermediate’ types of burn, being a depth between first & third degree burns
What is a second degree burn?
A second degree burn is a burn of the upper part of the skin. They may be superficial or deep second degree burns, depending on exactly how deep the burn injury has gone through the skin
How do people get second degree burns?
You can get second degree burns in a number of ways, but hot liquids are a common cause, especially in cooks. A tipped over boiling pan or freshly poured and spilled cup of coffee can quickly cause a second degree burn.
Any other cause of burns can also result in a second degree burn if the exposure is long enough- for example a flame injury, burn from a hot stove or chemical burn
Do second degree burns hurt?
Yes, they can be painful. Because a superficial second degree burn affects the top layers of skin only, the nerve endings are still intact and so pain is felt. A deeper superficial burn has had many of the nerve endings destroyed though, so may only be slightly painful. You can take simple painkillers to help with the pain
Are second degree burns dangerous?
Generally, whilst most second degree burns are of little consequence, 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’. 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 needed for burns larger than 10% in children and 15% in adults.
Additionally, as the skin has been damaged in a second degree burn, bacteria can now enter into the skin and bloodstream – this can cause redness, swelling and infection of the burn, or septicaemia and life-threatening illness (known as toxic shock syndrome).
How are second degree burns treated?
As described earlier, larger second degree burns are given intravenous fluids through a ‘drip’ (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. A catheter may also be required so that urine production can be monitored, which informs the clinician of how well hydrated the patient is.
Second degree burns are often treated firstly with cleaning and dressings. These dressings may be simple non-stick dressings or ones which contain silver to fight bacteria, agents to promote healing etc. If the burn is relatively superficial then it may well heal on its own in 1-2 weeks. A deeper second degree burn will eventually heal, but may do so with scarring – for this reason many burns specialists will opt to remove a deep second degree burn and perform a skin graft to speed healing and try to prevent problematic scarring and wound problems.
Second degree burns, therefore, may be treated differently according to just how deep the burn is – these burns, however, are notoriously difficult to assess, partially due to the fact that burns can change in depth over their first few days. Some specialists will therefore monitor the burn for a few days to see if it is one that is likely to heal on its own, or need surgery
Do second degree burns cause scarring?
Whilst superficial second degree burns often heal without noticeable scarring, deeper burns will heal with scarring. Additionally, any surgery that is needed will leave scars
What are the long-term issues of a second degree burn?
Scar contracture – if a deep second degree burn heals on its own and forms scars across a joint (for example the elbow), then as the scar matures it may contract (shrink). This may lead to an inability to fully move the joint, and so surgery may be needed to release the scar.
Slow healing – deeper second degree burns can take many weeks to heal on their own, and so burns specialists may use a skin graft to help healing. Occasionally a burn can heal up but with a thin, unstable scar – this can easily break down again and again, so surgery may be needed to try to get the area to heal fully.
Disfigurement – deeper burns, whether operated on or not, can leave scars that are very noticeable to you or to others. This is especially so when the burns are to the face. Whilst scarring can be improved by surgery or other means, there is unfortunately no way to completely remove them. The recent advances made in face transplant surgery may, however, provide hope for those with the most severe types of facial burn injuries.
Skin colour changes – whilst second 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), but can also be a darker patch (hyperpigmentation)
The list of consequences is not exhaustive, and the information provided is as a guide only. You should discuss matters fully with your specialist regarding any treatment required