Burns are common injuries, ranging from minor to severe, and can result from a variety of causes, such as heat, chemicals, electricity, or radiation. When a person experiences a burn, the severity depends on how deeply the burn affects the skin. There are three burn classifications: first-degree, second-degree, and third-degree. The degrees are staged based on the layers of skin impacted, e.g., the second degree involves the first and second layers of skin, and so on.

What Are Second-Degree Burns?

A second-degree burn (also known as a partial-thickness burn) affects both the outer layer of the skin (epidermis) and the underlying layer (dermis). This impacts the body’s ability to protect itself from infection. Skin plays a significant role in protecting us and is the body’s largest organ. The second layer of skin, the dermis, contains connective tissue, blood vessels, oil and sweat glands, nerves, hair follicles, and other structures.

How Are Second-Degree Burns Classified?

Second-degree burns are categorised into two subtypes based on the severity of the damage to the skin layers:

1. Superficial Partial-Thickness Burns
   • These burns affect the upper layer of the dermis, but the deeper layers remain intact. They are usually painful, with redness and swelling that may blister.
   • These burns typically heal within 2 to 3 weeks with proper care and usually leave no permanent scarring.
2. Deep Partial-Thickness Burns
   • These burns penetrate deeper into the dermis, potentially affecting sweat glands, hair follicles, and other deeper skin structures. The burn area may appear pale or waxy and can cause significant pain.
   • Healing time for deep partial-thickness burns can range from 3 weeks to several months, and there is a higher risk of scarring.

Scar tissue differs from normal skin in several ways, including:

• Collagen alignment: In normal skin, collagen fibres are arranged in a random, basket-weave pattern, while in scar tissue, they are aligned in parallel bundles. 
• Texture: Scar tissue is thicker and more fibrous than normal skin. 
• Lack of appendages: Scars don’t contain hair follicles or sebaceous glands, and the stem cells that usually reside in these structures are also absent.

Symptoms of Second-Degree Burns

The symptoms of second-degree burns depend on the severity of the burn, but the most common signs include:

• Red, blotchy skin: The area may appear red or pink, and in deep partial-thickness burns, it can look pale or waxy.
• Blisters: One of the hallmark signs of second-degree burns is the formation of blisters. These blisters may break open, but the skin underneath remains raw and painful.
• Swelling: The affected area can swell, leading to discomfort, pain or tightness in the skin.
• Pain: Second-degree burns are often very painful because they affect nerve endings in the skin. Pain can range from mild to intense, depending on the level of nerve exposure.
• Wet or shiny appearance: The burn may appear wet due to the moisture escaping from damaged tissues.

When to See a Doctor

While many second-degree burns can be managed at home with proper care, there are certain circumstances when medical attention from your general practitioner is necessary.

1. If the burn is large or covers sensitive areas:
   • A healthcare professional should always evaluate burns that cover large areas of the body (greater than 3 inches in diameter) or burns on sensitive areas such as the face, hands, feet, groin, or major joints.
2. If a chemical or electrical source caused the burn:
   • Chemical burns or burns caused by electricity (electrical burns) require immediate medical attention, as they can lead to deeper internal injuries that are not immediately visible on the skin surface.
3. If blisters are large or burst:
   • If the blisters are large, break open, or show signs of infection (such as pus, increased redness, or a foul smell), medical treatment is essential to assess for infection and provide treatment options.
4. If there are signs of infection:
   • Symptoms such as increased redness, swelling, pus, or fever indicate that the burn has become infected and requires medical intervention.
5. If you have pre-existing conditions:
   • Individuals with reduced immune systems, diabetes, or other conditions that affect their skin’s healing ability will benefit from specialised wound care.

First Aid for Second-Degree Burns

While seeking medical help is essential in certain cases, there are steps you can take at home to manage second-degree burns before professional care is available:

1. Cool the burn: Immediately place the affected area under cool (not cold) running water for 10 to 20 minutes to help reduce pain and inflammation. Burns continue to develop over 24 hours and benefit from ongoing cooling. If running water is unavailable, apply a clean, cool, wet cloth to the area.
2. Avoid breaking blisters: Do not pop or break blisters, as this increases the risk of infection. If blisters break on their own, gently clean the area and dress with a simple dressing. Monitor the area for infection, which is repaired by the skin.
3. Cover the burn: Use a sterile, non-stick dressing to cover the burn. Avoid using cotton balls or any material that can stick to the wound.
4. Take pain relief: Over-the-counter pain relievers can help manage pain and inflammation.
5. Keep the wound clean: Clean the burn with water daily, and apply antiseptic cream and a basic dressing.