A second degree burn, also known as a partial thickness burn, is a burn that affects both the outer and inner layers of skin. The damage goes through the entire epidermis (outer layer) and into the dermis (inner layer). Second degree burns are one of the most common types of burns seen in emergency rooms. While not as severe as third degree burns, second degree burns should still receive prompt medical attention to avoid complications and scarring.
What are the layers of skin?
Human skin is composed of three layers:
- Epidermis – This is the outermost layer of skin. It contains no blood vessels and is made up of basal, squamous, granular, and cornified cells. The epidermis acts as a protective barrier against the environment.
- Dermis – This middle layer contains blood vessels, hair follicles, and sweat glands. The dermis provides the skin with strength, elasticity, and cushioning. It also regulates temperature.
- Hypodermis – The deepest layer of skin consists mainly of fat and connective tissue. It anchors the skin to muscle and bone and provides insulation and shock absorption.
A second degree burn penetrates through the epidermis and into the dermis. It causes damage to both layers that must be treated to prevent infection and scarring.
Signs and symptoms
Here are the main signs and symptoms of a second degree burn:
- Pain – The burned area is very painful, even without touching it. The pain may feel intense and prickling as nerve endings are exposed.
- Reddened skin – Skin in the affected area appears very red, similar to a first degree burn. However, the redness is deeper and more intense.
- Blisters – Clear or milky colored fluid-filled blisters start to form. Blisters indicate separation between layers of skin.
- Weeping/raw skin – If blisters pop, they weep clear fluid and leave behind tender, raw-looking skin. This weepy appearance distinguishes second degree burns from more superficial first degree burns.
- Swelling – Burnt tissue often becomes swollen as the injury triggers inflammation and fluid buildup.
- Peeling – In the days after the initial burn, the damaged outer layer of skin starts to peel away, revealing new pink skin underneath as the burn starts to heal.
Levels of severity
Not all second degree burns are the same. Doctors grade the severity of second degree burns as either superficial or deep:
- Superficial – These affect only the upper part of the dermis. They are characterized by painful red skin with blisters and weeping clear fluid when blisters pop.
- Deep – These penetrate further into the lower dermis. They cause blotchy, swollen skin that looks white, red, pink, or mottled. The level of pain may be less because more nerve endings have been damaged.
Deep second degree burns take longer to heal and are more likely to scar without proper treatment.
Appearance on different skin tones
While the characteristics of a second degree burn are generally the same across skin tones, the visual appearance may differ slightly:
- Fair skin – Very red, almost a deep crimson in color. Blisters are clear.
- Medium/olive skin – Dark pink to cherry red color. Blisters are clear to cloudy.
- Dark skin – Can look pale, waxy, or glossy. Blisters are clear to milky.
Treatment
Second degree burns always require medical treatment. Home care is not recommended as it can lead to infection. Treatment involves:
- Cleaning the wound
- Applying antibiotic ointment or silver sulfadiazine cream
- Covering with a sterile non-stick bandage
- Pain management medication
- Tetanus shot
- Surgical debridement of any dead tissue
- Skin graft if the burn is deep and widespread
Healing time
On average, second degree burns take 2-3 weeks to heal. However, deep second degree burns can take several months to heal and are more likely to scar:
- Superficial – 10 to 21 days
- Deep – More than 21 days
Burns covering a large surface area will also require longer healing time than small, localized burns.
Scarring
Scarring is a common consequence of deep second degree burns. As the damaged skin heals, collagen production is disrupted, resulting in a thick, fibrous scar. Extensive scarring can lead to:
- Itchiness
- Tightness and restricted movement
- Uneven texture
- Changes in pigmentation
Scars tend to improve and fade over time. Early treatment with silicone sheets or gels may help reduce scarring.
Complications
Potential complications of second degree burns include:
- Infection – Signs include increased pain, redness, fever, pus.
- Scarring – As described above.
- Contractures – Tight, thickened scar tissue limits mobility of joints.
- Loss of skin function – Skin can’t regulate temperature or retain moisture.
- Fluid loss – Leads to electrolyte imbalances.
- Hypothermia – Difficulty retaining body heat.
Seek emergency care if any signs of complications develop after a second degree burn.
When to see a doctor
All second degree burns require medical attention. Seek immediate help if:
- The burn covers more than 3 inches.
- It occurred on the face, hands, feet or genitals.
- The victim shows signs of shock like low blood pressure, rapid heartbeat, or fainting.
- Burns are from chemicals, electricity or inhaled smoke.
For more minor burns, urgent care within 24 hours is recommended. Call a doctor if signs of infection develop.
Prevention
You can reduce your risk of suffering second and third degree burns by:
- Keeping the temperature of your hot water heater below 120°F.
- Staying focused while cooking and never leaving food unattended on the stove.
- Keeping space heaters away from flammable materials.
- Having a fire escape plan and working smoke detectors in your home.
- Exercising caution around campfires, grills, and fireworks.
- Using proper safety gear and techniques when working with hazardous materials.
Conclusion
Second degree burns penetrate through both layers of the skin and require medical care. They cause extreme pain and fluid-filled blisters at the site which weep clear fluid when popped. Second degree burns usually take 2-3 weeks to heal, with deep burns taking longer and being more likely to scar. Prompt and proper treatment reduces the risk of serious complications like infections and permanent skin damage.