Burns: Degrees, treatment and first aid (2)

Individual degrees of burns

We recognise three degrees of burns depending on the severity of skin damage and the cause of the burn. First-degree burns can usually be treated at home. In the case of second- and third-degree burns, it is always necessary to call for or seek medical assistance.

First-degree burns

Here only the epidermis (the outermost layer of skin) is damaged. First-degree burns are manifested as redness (erythema) and swelling, without blistering. The affected area is painful and sensitive, but healing occurs spontaneously after a few days, with no trace of scarring. The risk of infection is minimal – a typical example is sunburn, when the skin is red, possibly swollen and slightly painful.

Second-degree burns

Here both the epidermis and the upper part of the dermis are damaged. Depending on their severity, we can divide second-degree burns into two subgroups.

• Superficial (IIa) – in the case of shallower burns, the deep part of the dermis remains unaffected and thus enables the skin to recover in the damaged area. Blisters filled with fluid (plasma) form and are sensitive to touch. The wound heals spontaneously within two to three weeks and usually does not leave a scar. Such less severe second-degree burns are most commonly caused by scalding with water or steam.
• Deep (IIb) – in the case of deeper burns, the deep layer of the dermis is damaged and healing thus takes longer, i.e. three to six weeks. The skin is distinctly red or even whitish, and a deep fluid-filled blister forms at the place of the burn. Due to the damage to the deeper layer of skin, scars usually remain after healing. More severe second-degree burns can be caused by, for example, fire, prolonged exposure to hot water or hot oil. Antimicrobial dressings are suitable for treating deep second-degree burns in order to prevent infection. Treatment should be provided by a specialist.

Third-degree burns (necrosis, charring)

This involves irreversible damage to the skin in the full scope and destruction of the capillary network of the dermis. Wounds are white or greyish-white and painless (due to damage to nerve endings). Miniscule areas may heal through contraction of the surrounding tissue; small and larger areas often require a skin graft. Third-degree burns are very serious and require urgent medical attention.

Charring is damage to the skin and subdermal tissue, including damage to muscle fascia (membranous muscle sheaths), muscles, bones and other structures. Wounds require extensive removal of necrotic skin (debridement) and complete reconstruction of the damaged structures. In the event of a third-degree burn, it is of course necessary to immediately call 155 for medical assistance.

Source: Mohamed Nohassi, Unsplash

What to do about first-degree burns and sunburn

Cool the burned area with cold running water (for ten or more minutes, ideally until the pain subsides, but beware of general hypothermia in the case of children). This brings immediate pain relief and often prevents the development of a second-degree burn. As the next step in the treatment of first-degree burns, Panthenol Spray, for example, is suitable for cooling and soothing the affected area, accelerating regeneration of the skin and preventing any inflammation caused by solar radiation, for example. If the affected area is painful, spray and foam products are recommended.

Products containing aloe vera, which promotes healing and rehydration, are also suitable for cooling and soothing burned skin. Other ingredients in after-sun products, such as allantoin, support regeneration. It is also a good idea to replenish essential vitamins internally – beta-carotene, vitamin C and vitamin E.

How to treat second-degree burns

Again, it is appropriate to cool the burned area with cold running water (see above). Do not puncture any blisters that may arise, as the wound could become infected. The affected skin can be further treated as follows:

• Burn gels– Flamigel, for example, is a suitable product for treating minor scalding and burns. For subsequent treatment of burn scars, an appropriate choice is a self-drying silicone gel applied in a thin layer and left to work on the scar.
• Burn bandages– a special bandage can be used on smaller burns. Such bandages accelerate healing and prevent infection of the wound.
• Gels and bandages for blisters– the blister healing process can be accelerated with a hydrocolloid bandage, which protects the wound and absorbs pus. For more complicated burns with a risk of infection, a dressing containing silver or other special materials is appropriate, though this treatment should be carried out by a specialist. For blisters in the mouth, you can reach for a special hydrogel.
• Creams and ointments for treating burns– these products significantly support and accelerate healing, while also reducing tissue scarring. Standard calcium ointment, chlorophyll and calendula ointment and mallow ointment can also be useful in certain stages of healing. A burn cream containing dexpanthenol is also suitable. Please note, however, that these products must not be used on open wounds, as they are not sterile, and the ointment base may promote festering of the wound. Therefore, the time to choose what to apply to a burn is when the wound is healing.

Source: Camilo Jimenez, Unsplash

In the case of larger second-degree burns, cool the wound with pleasantly cold running water and call the EMT service at 155. If you are at a longer driving distance or if you transport yourself for treatment, cover the affected area with a sterile dressing or use that old classic in the form of tulle gras, i.e. special sterile tulle soaked in petroleum jelly to keep the wound moist. Then apply gauze or a bandage – be sure to prevent any surrounding fabric or other materials from sticking to the would – and seek professional medical assistance.

First aid in the case of burns

“First, immediately break contact with the source of the burn. Remove any burned or wet clothing, but never remove any burned material that has adhered to the skin. Cool the affected area with pleasantly cold running water or immerse the affected part in water until the pain subsides. However, never use ice, which can cause further damage the burned skin,” explains MUDr. Marek Dvořák, Ph.D., general practitioner for adults, who also works within the Doctor Online 24/7 service.

“Cooling can take several tens of minutes, so you should continue cooling the skin until a doctor arrives. This alleviates pain and reduces the depth of the burn. However, pay attention to the size of the area to be cooled, which should not exceed 10% of the body’s surface at any one time (risk of hypothermia). In the case of larger burns, do not apply any products to the skin and immediately seek out a doctor, who will determine the most appropriate course of action,” MUDr. Dvořák adds.

When to call for help

Milder burns (first- and second-degree) can usually be treated at home. However, always call the EMT service immediately if you are unsure of the extent of the burned area (1% is equal to the palm of the hand with the fingers), if the burn is larger in size (5% second-degree or more) or if the burn victim is a senior citizen or small child. Call the EMT service even if the burn penetrates all layers of the skin, some skin is missing or blisters appear. Another sign of a very severe burn is charring of the skin, brown or black spots, or a smooth, shiny and bright red burned area of skin. Inhalation trauma caused by inhaling flame is also dangerous and can be recognised by the injured person’s singed eyebrows and nose hair and difficulty breathing. This condition can result in swelling of the airway and suffocation. Also keep in mind that the most severe burns are not painful, because the nerve endings have been damaged.

You can also turn to the specialists at EUC for follow-up treatment.

EUC general practitioners