Burn Depth - Classification, Assessment, Characteristics.

5 Key Points on Burn Depth Assessment

1. Burn depth is classified into superficial, partial, and full-thickness.
2. Assessment focuses on colour, pain, blanching, blisters, sensation.
3. Superficial burns are like sunburn - hot, red, painful, no blisters.
4. Partial-thickness burns have blisters as the dermis is now involved.
5. Full-thickness burns can be charred, leathery, and insensate.

Burn Depth Classification

The following chart and table outline the assessment and characteristics for each burn depth.

Burn depth and total body surface area of a burn are two key aspects of a burn assessment. The assessment of burn depth, and as such, the estimation of whether a burn wound is expected to heal on its own within 21 days, is one of the most important roles of the burn surgeon⁴.

Currently, the determination of burn depth based on clinical examination is only 70% accurate¹. It can be difficult to effectively stratify burn wounds.

A burn is a dynamic process for the first few days and a burn that appears shallow on day 1 may appear deep by day 3². A deeper burn may require more fluid resuscitation.

Despite the plethora of technological advances, the most common technique for diagnosing burn depth remains the clinical assessment of an experienced burn surgeon. A clue is often in the history - type of burn and immediate first aid.

You can download this burn depth chart with the link below.

Burn Depth Classification

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Tip: it's very rare for a burn to be one specific depth. The majority of burns are "mixed thickness" with one depth more present than the others.

Superficial Burn Depth (1st Degree Burns)

A superficial burn is similar to a "sunburn" - red, painful, and generally resolves over a few days.

A superficial burn (1st degree) has the following characteristics:

Involve the epidermis
Warm, painful, red/erythematous, soft, and blanching.
No blistering.
A typical example is a sunburn.
Healing by rapid re-epithelialization³

Burn Classification, Depth, Burn, Chart, Superifical, 1st Degree, Superificial Partial, Sunburn, Burn Depth — Superficial Burn

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Tip: Areas of redness or erythema are not included in the calculation of the total body surface area of a burn. Therefore, it does not influence the volume of fluid resuscitation.

Partial Thickness Burn Depth (2nd Degree Burns)

A partial-thickness burn has 3 subclassifications: superficial-dermal, mid-dermal, and deep-dermal

Superficial dermal partial thickness

A superficial partial-thickness burn (2nd degree) has the following characteristics:

Involves epidermis and into the papillary dermis
Painful, red, blistered, moist, soft, and blanching when touched.
When blistered are deroofed, the skin is moist, red, and hypersensitive.

Burn Classification, Depth, Burn, Chart, Superfical-Partial, Blisters, 2nd Degree, Superficial Partial, Burn Depth, Assessment, Characteristics — Superficial-Partial Thickness Burn

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Tip: Blisters are a collection of fluid between the interface of the epidermis and dermis. If there are blisters, it means the burn cannot be superficial.

Mid dermal partial thickness

Burn Classification, Depth, Burn, Chart, Mid-Partial, Blisters, 2nd Degree, Mid Partial, Burn Depth, Assessment, Characteristics — Mid-Partial Burn

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Tip: Burns that heal within 3 weeks generally do so without hypertrophic scarring or functional impairment, although long term pigmentary changes are common

Deep dermal partial thickness

A deep partial-thickness burn (2nd degree) has the following characteristics:

Involves epidermis and into the reticular dermis
It can also blister but is less likely than a superficial dermal burn.
The wound surface is usually a mottled pink immediately following the injury and overtime may progress to a whiter and drier wound.
Blanching is minimal or non-existent (due to capillary damage)
Reduced sensation and less pain.

Full Thickness Burn Depth (3rd Degree Burns)

A full-thickness burn is an insensate, non-blanching, painless burn that can have an overlying black eschar or feel like leather.

A full-thickness burn (3rd degree) has the following characteristics:

Involve epidermis, dermis, and into the subcutaneous fat or deeper.
Minimal or no pain
Colour can be white, brown, or charred
Feel firm and leathery with no blanching.

Burn Classification, Depth, Burn, Chart, Full Thickness, Eschar, 3rd Degree, Burn Depth, Assessment, Characteristics — Full Thickness Burn

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Tip: Superficial Burns and Full Thickness burns don't have blisters!

Flashcards on Burn Depth

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References on Burn Depth

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Thank you to Abdulrahman Abdulaziz Alghamdi for his contribution to this article.

Bezuhly, Michael F.R.C.S.C.; Fish, Joel S. F.R.C.S.C. Acute Burn Care, Plastic and Reconstructive Surgery: August 2012 - Volume 130 - Issue 2 - p 349e-358e doi: 10.1097/PRS.0b013e318258d530
Heimbach D, Engrav L, Grube B, Marvin J. Burn depth: a review. World J Surg. 1992 Jan-Feb;16(1):10-5. doi: 10.1007/BF02067108. PMID: 1290249.
Monstrey S, Hoeksema H, Verbelen J, Pirayesh A, Blondeel P. Assessment of burn depth and burn wound healing potential. Burns. 2008 Sep;34(6):761-9. doi: 10.1016/j.burns.2008.01.009. Epub 2008 Jun 3. PMID: 18511202.
Amín D. Jaskille, MD, Jeffrey W. Shupp, MD, Marion H. Jordan, MD, James C. Jeng, MD, Critical Review of Burn Depth Assessment Techniques: Part I. Historical Review, Journal of Burn Care & Research, Volume 30, Issue 6, November-December 2009, Pages 937–947, https://doi.org/10.1097/BCR.0b013e3181c07f21

Burn Depth - Classification, Assessment, Characteristics.

In this Article

5 Key Points on Burn Depth Assessment

Burn Depth Classification

Superficial Burn Depth (1st Degree Burns)