Burns are classified by severity, generally categorized into first, second, third, fourth, and fifth degree burns. First degree burns are the mildest burns that only affect the outer layer of skin. Second degree burns go deeper into the skin, causing blistering. Third degree burns destroy the entire epidermis and dermis, leaving charred tissue. Fourth degree burns go even deeper, damaging muscle and bone. Fifth degree burns are the most severe, extending into fat and organs. The depth and extent of tissue damage increases with each degree. So fifth degree burns are considered the highest burn degree due to their devastating impacts on the body.
First Degree Burns
First degree burns, also called superficial burns, only affect the outer layer of the skin, called the epidermis. The burn site is red, painful, dry, and non-blistered. Although the epidermis is damaged, it can regenerate itself and heal within 3-6 days. First degree burns generally do not scar unless they cover a large surface area. What causes first degree burns? Common causes are sunburns, brief contact with hot surfaces, scalding water, or steam. A mild first degree burn looks similar to a sunburn.
Signs & Symptoms
- Red, inflamed skin
- Pain and itching sensation
- Dry skin with no blisters
- Mild swelling
- Peeling skin as it heals
Treatment
First degree burns can be treated at home with:
- Cool running water to reduce pain and inflammation
- Aloe vera gel to soothe and moisturize
- OTC pain medication like acetaminophen or ibuprofen
- Antibiotic ointment to prevent infection
- Loose, non-stick bandage
- Avoiding re-injury and sun exposure as it heals
Most first degree burns heal within 3-6 days with proper care. See a doctor if the burn covers a large area, looks infected, or does not start to heal within a week.
Second Degree Burns
Second degree burns go deeper into the skin layers, damaging both the outer epidermis layer and the inner dermis layer of skin. This causes pain, redness, blistering, and more extensive tissue damage. Second degree burns take longer to heal and will often scar. There are two subtypes of second degree burns:
Superficial Second Degree Burns
Superficial second degree burns involve the topmost part of the dermis. They cause pain, redness, swelling, and blisters. Blisters are filled with clear fluid and are indicative of nerve damage in the dermis. Superficial second degree burns can heal within 2-3 weeks.
Deep Second Degree Burns
Deep second degree burns go deeper into the dermis, closer to the nerve endings. This causes more severe blistering, pain, redness, and swelling. The blisters may rupture, leaving exposed, sensitive tissue. Deep second degree burns take longer to heal, often 3-6 weeks. They are also more likely to cause scarring due to extensive dermal damage.
Signs & Symptoms
- Wet, weeping blisters
- Intense pain and swelling
- Red or mottled skin
- Sluggish capillary refill
- Fatigue, nausea (with large burns)
Treatment
Second degree burns require medical treatment, including:
- Cleaning with mild soap and water
- Antibiotic ointment or cream
- Non-adhesive bandages or dressings
- Pain management with medication
- Close monitoring for infections
- Skin grafting for deep second degree burns
- Physical therapy to prevent scarring contractures
Third Degree Burns
Third degree burns, also called full thickness burns, destroy the entire outer epidermis and inner dermis layer of skin. This can cause the skin to appear charred, leathery, or white. There is typically no pain at first because the nerve endings themselves are damaged. Third degree burns require grafting and leave significant scarring because the skin’s regenerative layer is lost. Full thickness burns take months to heal.
Signs & Symptoms
- White, brown, black, or charred skin
- Dry, leathery texture
- Absent blisters or pain
- Difficulty moving area
- Nausea, dizziness, fatigue (with large burns)
Treatment
Third degree burns require hospitalization and surgery, including:
- Intravenous fluids and medications
- Wound cleaning and debriding
- Skin grafting, often with cadaver skin or skin from unaffected areas of the patient’s body
- Compression bandages and garments as it heals
- Extensive physical therapy and rehabilitation
With proper treatment, the grafted skin eventually blends in color and texture with the surrounding tissue. However, the skin remains scarred and lacks hair follicles, oil glands, and normal sensation.
Fourth Degree Burns
Fourth degree burns extend deeper through the skin into muscle, tendons, and bones. They destroy skin along with the underlying fat, nerves, blood vessels, and muscle. This requires extensive surgery, skin grafting, and rehabilitation. There is high risk for many complications including lasting deformities, chronic pain, and loss of function. Healing can take months or years.
Signs & Symptoms
- Burns extending deep into tissues beneath the skin
- Loss of elasticity and muscle movement
- Charred black, brown, white skin
- Numbness from severed nerves
- Joint stiffness or exposed bone
Treatment
Fourth degree burn treatment involves:
- Aggressive fluid resuscitation
- Surgical debridement and skin grafting
- Muscle transfers or flaps
- Treatment for damaged tendons, joints, bones
- Intense physical and occupational therapy
- Psychological counseling
Despite best efforts, fourth degree burns often result in disfigurement, chronic pain, reduced mobility, and permanent disabilities.
Fifth Degree Burns
Fifth degree burns, the most severe, extend into the fat and deeper tissues beneath the skin. The damage goes all the way through the muscle down to the bone. Fifth degree burns frequently expose bones and organs and require radical surgical intervention to save the patient’s life.
Signs & Symptoms
- Extreme depth of tissue destruction
- Exposed bone or organs
- Loss of entire regions of skin and muscle
- Little chance for recovery of function
- Require amputation in some cases
Treatment
Fifth degree burns require aggressive, long-term treatment including:
- Emergency IV fluids and metabolism support
- Excision of dead tissue and amputation of unsalvageable limbs/digits
- Skin flap transplants or skin grafting of available donor sites
- Treatment of damaged internal organs, bones
- Prosthetics and intensive rehabilitation
- Lifelong physical and psychological therapy
Fifth degree burns often result in permanent disfigurement over massive regions of the body, if not death. Survival requires extraordinary efforts to stabilize, graft tissue, restore vital functions, and rehabilitate the patient.
Burn Degree Comparison
Here is an overview comparing the different burn degrees:
| Burn Degree | Depth of Skin Damage | Appearance | Healing Time |
|---|---|---|---|
| 1st Degree | Outer layer (Epidermis) | Red, no blisters | 3-6 days |
| 2nd Degree – Superficial | Epidermis + upper dermis | Blisters, wet | 2-3 weeks |
| 2nd Degree – Deep | Epidermis + deep dermis | Blisters, ruptured | 3-6 weeks |
| 3rd Degree | Full thickness (epidermis + dermis) | Leathery, charred, white | Months |
| 4th Degree | Into fat, muscle, bone | Charred, black | Months to years |
| 5th Degree | Through muscle into bone and organs | Extreme destruction | Years to fatal |
Conclusion
In summary, fifth degree burns are considered the highest and most severe burn degree. They extend deeper through the skin layers, muscles, fat, and bones, sometimes damaging internal organs. Fifth degree burns result in extreme tissue damage that is often fatal or requires amputation. They necessitate radical surgical treatment, skin grafting, and lengthy rehabilitation to survive. While all burns should receive urgent medical care, higher degree burns become progressively more dangerous. So fifth degree burns represent the top tier of burn classifications due to their substantial impacts on the body. Prompt and appropriate treatment offers the only hope for survival and recovery.