First Aid for First-, Second- and Third-Degree Burns

Boiling liquid, a hot curling iron, electrical fires or bonfires — burns can come from a variety of sources and they appear in all shapes and sizes. But how you treat a burn depends on where it’s located and how deep and severe the damage is.

Urgent care physician Allan Capin, MD, explains what you should have on hand for burn treatments, when you should seek medical assistance or emergency services, and how to treat a burn in the moments after it happens.

First aid for burns

When it comes to burns of any kind, the faster you treat them, the lower the likelihood that you’ll develop an infection. So, acting fast and knowing when to seek emergency help is very important.

“When there’s any kind of breach in your skin, there’s going to be a risk for infection,” stresses Dr. Capin. “The worse the burn, the higher the risk of infection because the deeper it penetrates into your skin. Any infection can lead to bigger problems, like sepsis, which is your body’s exaggerated response to a systemic infection.”

You should have these first aid items on hand in case you need to treat a burn:

• Cool water or saline solution. Use these to immediately cool off the burn area.
• Non-stick sterile dressings. These should be used to cover the burn safely without sticking to the wound.
• Hydrogel burn dressings. These provide cooling and pain relief.
• Burn cream or ointment. Aloe vera gel or antibiotic ointment can soothe a first-degree burn and help prevent infection. Do not use ointments, creams or sprays for second-degree burns or worse. These will likely require a stronger antibacterial prescription cream like silver sulfadiazine (Silvadene®).
• Pain relievers. Over-the-counter medications like ibuprofen (Advil®) or acetaminophen (Tylenol®) can help manage pain.
• Adhesive bandages. These are used to secure dressings in place.
• Scissors. You’ll need these to cut dressings or bandages to size.
• Tweezers. You may need these to help remove any debris from the burn area, like tight jewelry. Never use these on your own to remove clothing, blisters or dead skin from a burn. These actions should be reserved for a medical professional.
• Gloves. Disposable gloves can help limit the possibility of infection or dirt getting into a wound while treating the burn.
• Cling film or plastic wrap. These can be helpful for covering the burn if sterile dressings aren’t available.

Treating first-degree burns

First-degree burns are superficial, meaning they’re minor and only affect the epidermis or the outer layer of your skin.

“There are no blisters or breaks in the skin with first-degree burns,” clarifies Dr. Capin. “These are closer to what a sunburn would be and they usually happen when you touch a hot object or get splashed with hot liquid.”

Here’s how to treat a first-degree burn at home:

1. Use cool (not cold) water. Apply cool water for five to 20 minutes by gently running tap water over the burn, dipping the burned area in water or using a clean, wet towel. Never use ice or ice-cold water, as this could reduce blood flow and prolong the healing process.
2. Moisturize. After the skin has cooled, lightly apply a moisturizer like aloe vera gel or petrolatum jelly (Vaseline®). This helps the healing process and adds water back into the damaged layer of your skin.
3. Protect. Use a clean, dry cloth or nonstick bandage to protect the burn from further infection, pressure or rubbing against anything.
4. Treat the pain. Take ibuprofen or acetaminophen if the burn is still painful.
5. Clean and prevent infection. While the burn heals, clean it with mild, antibacterial fragrance-free soap as needed and use an antibiotic cream to prevent infection.

Treating second-degree burns

Second-degree burns, or partial-thickness burns, are more serious because they tend to cover more surface area and cause further damage deep beneath your skin. If you experience blistering in your skin, you likely have a second-degree burn. Second-degree burns are also at risk of tetanus, so you’ll likely need a tetanus vaccine if you’ve not had one in the last 10 years.

Any burn worse than a first-degree burn should be seen by a medical professional immediately.

“The more time you take with a second- or third-degree burn, the higher the likelihood you can have an infection or mismanage the treatment of it,” warns Dr. Capin. “If you’re not sure what to do, or you can’t tell if it’s a second-degree burn, don’t guess: Go to your local urgent care or emergency room immediately.”

In the moments after you are (or someone is) burned and before you seek medical treatment, there are some things you can do (and shouldn’t do) to help minimize the damage:

• Use cool, clean running water. Don’t use water that might be contaminated, like from a lake, river or stream, as bacteria in the water may cause an infection. If you don’t have access to tap water, use bottled water. It’s also OK to use a clean, wet towel.
• Don’t pull clothing away from the burn. If anything is stuck to the burn, don’t pull it off. Let healthcare providers at urgent care or the emergency room do that for you.
• Don’t use any ointments or sprays. Butter, oil, ointment and first-aid sprays will slow the release of heat from your skin, making the wound worse.
• Never pop a blister. The skin beneath the blistered area can easily become infected, so let a healthcare provider drain and remove it. If a blister pops on its own naturally, cover the area with cling film or plastic wrap until you’re able to see a healthcare provider.

Treating third-degree burns

“Third-degree burns can go all the way down to the bone and they tend to result in white, black or charred skin, nerve damage and numbness,” explains Dr. Capin. “Third-degree burns are medical emergencies and you should go straight to the emergency room if this happens to you.”

Electrical burns and chemical burns tend to fall in this category of full-thickness burns.

When to seek medical care

Remember: Anything worse than a surface-level burn with broken skin should be seen by a healthcare provider right away. They’ll be able to assist with cleaning and treating the burn, as well as provide stronger forms of pain management.

When it comes to first-degree burns, you may need medical attention if the burn is:

• More than three inches wide
• Covering a joint
• On your face, neck, hand or foot
• Causing pain that doesn’t go away
• Not healed in one to two weeks

A first-degree burn is still at risk for infection, so if your burn starts taking a turn for the worse, go to urgent care or the emergency room. Symptoms to watch for include:

• Fever
• Pus
• Increased pain or pain that expands or spreads to other areas of your body

“The worse the burn is, the longer it takes for it to heal,” states Dr. Capin. “Third-degree burns can take months or more to heal and may need surgical interventions like skin grafting. First- and second-degree burns can take a week or more to heal, depending on the severity of damage that’s been done. But the sooner you treat the burn, the better the outcome.”