What is First Degree Burn?
First-degree burns are minor burns that only affect the outermost layer of the skin, known as the epidermis. Our skin, which makes up almost 16% of our body weight, is our largest organ. It’s made up of three layers – the epidermis, the dermis and the hypodermis. The skin has several roles: it protects our body, helps control our temperature, manages our body’s evaporation, aids in excretion, and allows us to feel sensations like heat, cold, pressure, and touch.
In terms of development, the epidermis, where first-degree burns occur, comes from a type of tissue known as ‘ectoderm’. Certain cells in the epidermis are specialized for our body’s immune response, these cells are called Langerhans cells and originate from our bone marrow. There are also cells called melanocytes and Merkel cells which are involved in skin color and sensation of pressure respectively, and they come from a tissue type known as ‘neural crest’. The epidermis does not have its own blood vessels, it gets its nutrients from blood vessels in the dermis, the layer of skin below it.
Under the microscope, the epidermis appears as a layer of cells that are flat and stacked, a structure called ‘stratified squamous epithelium’. These cells are mainly ‘keratinocytes’, a type of cell that produces keratin, a protein that helps protect our skin. The epidermis itself can be divided into various layers, from bottom to top they are: stratum germinativum, stratum spinosum, stratum granulosum, and the outermost layer, stratum corneum.
What Causes First Degree Burn?
Burns can be sorted into categories by how they happened, how deep the burn penetrates the skin layers, and how severe the burn is. The usual types of burns are thermal burns (heat burns), electrical burns, chemical burns, radiation burns, and non-accidental burns.
Thermal burns often occur because of fires, hot drinks, or touching something hot. ‘Scalds’ which are a type of thermal burns, happen when skin gets exposed to something like hot bath water, hot beverages, hot oils, or steam. Kids under 5 and older adults are more likely to get scalds. These usually result in first or second-degree burns, but long exposure times could cause third-degree burns.
Electrical burns happen because of contact with high tension wires, low tension wires, or from flashing electric arcs. They are mostly found in kids playing with electrical plugs and inexperienced adults dealing with electrical circuitry. It’s sometimes possible to see where the electric current entered and exited the body. These burns can lead to serious issues like abnormal heart rhythms and the release of a muscle protein, myoglobin, into the urine due to tissue damage.
Chemical burns happen when the skin or the inside of the mouth comes into contact with a strong acid or base. Typical household products like drain cleaners, paint thinners, and lye can cause these burns. Alkali burns are typically more serious since they cause a type of tissue death called liquefactive necrosis. Acids, on the other hand, cause coagulative necrosis.
Radiation burns are caused by lengthy exposure to ultraviolet light—like sun rays or radiation from tanning booths—or due to ionizing radiation therapy or X-rays. Sunburn is the most common first-degree burn from radiation. The skin pigment melanin can protect the skin to some extent from sunburn. The stages of sunburn include tan, red, purplish-red, and blister red. Tanning happens due to increased melanin, and leads to red and sensitive skin. Continued exposure can cause swelling and purplish discoloration. The final stage can lead to blister formation and skin peeling.
Non-accidental burns result from assault or carelessness and are commonly due to thermal injury. One should be suspicious of these in children, when burns are even, covering from feet to legs and the perineal area, and when there are many burns.
Burns can also be classified based on which layer of skin they affect and are termed degrees. The American Burn Association provides these burn degree classifications:
- Superficial or first-degree burns: affect the outer layer of the skin, called the epidermis (like a sunburn)
- Superficial partial-thickness or second-degree burns: affect the top layer of the second layer of skin, called the dermis
- Deep partial thickness or second-degree burns: extend into the superficial dermis
- Full-thickness or third-degree burns: affect the entire second layer of the skin
- Fourth-degree burns: these burns go through the entire skin and affect underlying fat, muscle, and bone
Risk Factors and Frequency for First Degree Burn
Between 2009 and 2015, fewer young people in the United States were using indoor tanning. Despite this decline, an alarming three-quarters of those studied reported experiencing at least one burn from the practice.
Signs and Symptoms of First Degree Burn
When dealing with burns, doctors need to find out certain information from the patient such as their age, gender, lifestyle, and in the case of kids, details about their family, birth, and development. It’s critical to understand how the burn happened, when it occurred, and if there is any associated pain. A first-degree burn is often more sensitive to touch, reddened in color, and may lead to skin peeling, depending on how long ago the burn happened. A part of the examination involves estimating the total area of the skin that’s been burnt. This is done using something called the ‘rule of nines’.
Testing for First Degree Burn
When dealing with burns, the severity of the injury will determine the steps doctors take in the initial evaluation, following a protocol called advanced trauma life support (ATLS). This protocol essentially involves two key steps or “surveys.”
In the first step, the “primary survey,” your doctors will focus on your ABCs: airway, breathing, and circulation, and also check for disability and exposure:
– Checking your airway with regard to your neck’s stability ensures that you can breathe correctly.
– Breathing and ventilation checks involve assessing if you’re breathing typically or whether any injuries could seriously affect your breathing, such as a tension pneumothorax, which is an urgent chest injury that can cause your lung to collapse.
– For circulation and control of any bleeding, doctors will check if your pulse is okay. They will assess your consciousness level and look for any signs of adequate liquid circulation in your body, such as skin color. If you are bleeding, they will identify the source and manage it immediately.
– Checking for disability involves a quick neurologic evaluation to confirm your awareness level, pupil size and response, signs of one-sided weakness, and potential spinal cord injury.
– Lastly, exposure involves examining your body thoroughly while ensuring you’re kept warm to prevent hypothermia.
After finishing this primary survey, a second detailed evaluation, or “secondary survey,” is performed to judge the extent and depth of your burns and whether they occur all the way around a part of your body.
In cases of first-degree burns, patients usually don’t show any airway troubles. So here, a thorough record of your health history and a detailed physical exam is ideally performed. Lastly, your doctor will estimate and record the size and depth of your burn to create an appropriate treatment plan.
Treatment Options for First Degree Burn
Burns can be sorted into three types: minor, moderate, and major burns. Each type requires different levels of care.
Minor burns, like first-degree burns, are usually not too severe. They can be treated at home or in a doctor’s office. The main goals are to ease the pain and keep the burn clean. Pain can be relieved with oral pain killers or creams applied directly to the burn, like Silvadene, 3% Bismuth Tribromophenate, or petroleum gauze. The burn area should be cleaned regularly to remove the peeling top layer of the skin. Dressings that don’t stick to the skin are useful, especially for burns on children or burns near the joints. These dressings should be changed three times a week as long as there’s no infection. If an infection occurs, the dressing needs to be changed daily, and the wound needs to be checked each day. Flucloxacillin, an antibiotic, is typically the first choice for treatment, or patients can use erythromycin. If a patient can’t use erythromycin, they can use clarithromycin instead.
Moderate burns should be treated in a hospital. Severe burns need to be treated in a specialized burn center. These burns are more serious, and the professionals in these settings are experts at managing burn injuries.
What else can First Degree Burn be?
These are some conditions that might resemble each other:
- Cellulitis (skin infection)
- Insect bite
- Allergy
