second degree burn

Classification

• superficial partial thickness
  • epidermis destroyed, partial dermal destruction
  • blisters, weeping, sloughed skin, red
  • painful to air & touch, blanches
• deep partial thickness
  • epidermis & dermis destroyed
  • wet or dry
  • white, yellow or red
  • painful to pressure

Etiology

• see burn

Pathology

• full thickness epidermal burn with the dermis remaining largely intact

Clinical manifestations

• 1st & second degree burns are hypersensitive & painful
• erythema
• tenderness
• edema
• 2nd degree burns
• blisters
• shiny appearance
• weeping
• second-degree, deep partial-thickness burn
  • destruction of the epidermis & the dermis
  • wet or dry wound painful only to pressure
  • may be any color, most commonly white, yellow, or red.

Complications

• see burn

Management

• debridement
  • intact blisters may be left for 3-4 days if no sign of infection
  • bulky blisters may be decompress & devitalized skin removed
• gentle cleansing with antiseptic or mild soap
• topical antibiotics
  • bacitracin for very limited 2nd degree burns
  • silver sulfadiazine (Silvadene) is preferred agent for larger or deeper burns
• dressings
  • non-adherent gauze next to skin covered by bulky dressing
  • wounds of face & ears may be easier to treat without bandages
  • daily dressing changes (premedication may be required)
• tetanus prophylaxis
  • tetanus toxoid 0.5 mL SC booster
  • tetanus immune globulin (Hyper-Tet) 25 U IM plus tetanus toxoid 0.5 mL SC if never immunized
• 2nd degree burns heal spontaneously without scarring in 2-3 weeks

More general terms

• burn