The Severity of Burns and How to Treat Them

How severe or dangerous a burn is depends on three things: how deep the burn is, the size of the area of skin involved and where on the body it is located.

The skin is one of the best defenses the body has, and it is the most important means of regulating the body temperature. Skin is the first line of protection against microorganisms like bacteria. If the skin is broken, germs can enter and start an infection that spreads to the rest of the body. Therefore, treating burns quickly and properly is very important.

Burn treatment

Three Levels of Severity

The skin has three layers:

  • The epidermis, which is the outer layer and can regenerate itself after a burn or other injury. It is the only layer that can do this.
  • The dermis is the middle layer and is made of collagen and elastic fibers. It contains sweat glands, hair follicles and blood vessels.
  • The bottom layer, the hypodermis or subcutaneous tissue, is where larger blood vessels and nerves are found.

Burns are considered more serious the deeper into the three layers they go.

  • First degree: A burn that affects the epidermis only, not causing the skin to break. It causes local inflammation and is superficial. There is redness, pain, and tenderness. It may become swollen. Sunburn is an example. However, a burn can “mature,” which means it can become deeper even after being removed from the cause.
  • Second degree: A deeper burn which is also painful, red and inflamed but has caused blistering. Fluid may accumulate around the wound.
  • Third degree: This is the most serious burn with all the layers involved. It destroys the area of skin involved, including the nerves and blood vessels. The area may look white or leathery and be less painful because of the nerve damage.


First degree:

  1. To alleviate the pain and to help stop the burn from maturing, hold the burn under cool running water or place it underwater. Make sure the water is cool and not hot.
  2. Protect the burn with a non-stick, sterile pad or clean cloth. Do NOT put butter or ointment on the burn. They may cause infection.
  3. Give acetaminophen, ibuprofen, or naproxen for pain.
  4. See a doctor if signs of infection are seen – more pain, redness, swelling, oozing or fever. Also get professional treatment if pain gets worse and redness lasts more than a few hours. The victim should get a tetanus shot or booster if needed.

Second degree:

Follow directions above for cooling burn. Do NOT apply ice, it may cause damage. Do NOT break any blisters, apply butter or ointment, which may cause infection. Protect the burn: cover as above and secure with tape or gauze. The victim must be protected from developing shock.

  1. Lay the person flat and have him/her elevate the feet about 12 inches.
  2. Elevate the burn area above the heart if possible.
  3. Keep the person warm with a blanket or coat.
  4. Do NOT move the patient in any way if it causes pain.
  5. Contact a physician for further instructions.

Third degree: Call 911. In the meantime:

  1. Protect the burn by covering it loosely with a non-stick, sterile bandage or a large area with a sheet or material that won’t leave dust or particles of lint in the burned area.
  2. Don’t soak in water or use butter or ointment due to possible infection.
  3. If fingers or toes are burned, separate them, if possible, with sterile gauze dressings.
  4. Follow instructions for preventing shock above UNLESS the person has injuries to the head, neck, legs or will have any discomfort being moved.
  5. Do NOT place a pillow under the head if the person has burns to the mouth, throat or windpipe. Doing this may cut off breathing.
  6. Have a person with facial burns sit up.
  7. Monitor the pulse until emergency team arrives.

All burn victims should have follow-up visits with a physician.

Always call 911 if the burn goes through all three layers of skin and looks whitish or brownish with black patches or looks leathery or charred. Also call if there is a blister over 2 inches in size or if it is oozing, or if the hands, feet, face or genitals are burned. Call if the victim is an infant or senior.

Calculating Risks

Another way of determining the severity is by comparing the area of the burn to the entire surface of the skin. For example, if a victim has an arm that has been burned severely over its whole surface, that would be 9% of the total body surface because 9% is the approximate percentage of an arm to the whole body surface.

If more than 20% of the body surface is burned, there is an elevated risk the victim will suffer from shock. Above 50%, there is an increasing chance of death depending on age, general health and other factors. The greater the burn surface, the higher the mortality rate.