A second-degree burn extends past the outer layer of skin into the dermis beneath it, so it looks red or pink and moist, blisters, and hurts a great deal, with pain that worsens on touch or exposure to air. It is divided into superficial partial thickness, the commoner form, which usually heals in about two to three weeks with good care, and deep partial thickness, which looks paler, feels less sensitive, takes longer and may require excision and skin grafting. This distinction cannot be settled from a photograph or a description: burn depth can evolve during the first forty-eight hours, which is why it is reassessed clinically rather than judged once. The most important step happens before you reach a doctor. Remove the heat source, then hold the area under **cool running water for ten to twenty minutes** and take off rings, watches and any clothing that is not stuck to the skin. Do not use ice or iced water: it reduces blood flow and can deepen the burn. Do not apply toothpaste, olive oil, ghee, coffee, salt or egg. These widespread myths raise the risk of infection and hide the real depth from the treating team. Do not burst blisters or peel their roof; the blister is a living cover that reduces pain and keeps bacteria out, and the decision to drain a large blister belongs in the clinic with sterile instruments. Clinic treatment rests on gentle cleansing, appropriate blister management, and a dressing that keeps the wound at the right moisture level and is changed on a planned schedule, with adequate pain relief before each change, surveillance for infection and confirmation that tetanus cover is up to date. Extensive burns or burns in critical sites are managed with a surgical team and may need an operation if they do not close within the expected time. Go to the emergency department without waiting if the burn is wider than the injured person's palm, involves the face, neck, hands, feet, joints or genital area, encircles a limb, or was caused by electricity or a chemical, and likewise if the patient is a child, pregnant, elderly, diabetic or immunosuppressed. The limits of treatment should be equally clear: no cream makes a wound heal faster than the skin can regenerate, topical antibiotic alone does not prevent infection, a deep burn will not close with dressings alone, and some burns leave a colour change or a scar even with ideal care. Suitability for any procedure is decided by clinical examination, not by reading.
Procedure steps
- 1
Correct cooling and home first aid
Ten to twenty minutes of cool running water is the first treatment, followed by a clean non-adherent covering. No ice, toothpaste, oil, salt or egg. Do not burst blisters, remove jewellery early before swelling starts, take a simple painkiller if it is not contraindicated for you, and keep the rest of the body warm, especially in children.
- 2
Assessing depth and extent in clinic
The doctor examines colour, moisture, capillary refill and pain sensation to separate superficial from deep partial-thickness burns, estimates the burned area as a percentage of body surface, and records the site and any circumferential involvement. Mechanism and contact time, chronic illnesses and tetanus status are reviewed, and the need for urgent referral to a burns unit is decided.
- 3
Wound cleansing and the blister decision
The wound is cleansed with a gentle solution and loose skin plus any wrongly applied substances are removed. Small blisters are usually left intact; large ones, those over a joint, or those likely to rupture may be drained or deroofed with sterile instruments in the clinic, with suitable analgesia beforehand and close watch for any sign of infection.
- 4
The right dressing and a change schedule
The dressing is chosen according to site, exudate volume and pain level, aiming for a balanced moist environment that speeds regeneration while reducing pain and the number of changes. Review appointments are set for dressing changes and wound inspection, the patient is taught the signs of infection, and topical or oral antibiotics are prescribed only when the doctor judges infection likely.
- 5
Reassessment and scar care
If the wound is not clearly progressing within the expected window, depth is reassessed and the need for excision and grafting is discussed. Once closed, a scar programme begins: moisturising and massage, strict sun protection for months, pressure garments or silicone when indicated, and exercises for any nearby joint to prevent the scar tightening across it.
Before the procedure
Before your appointment, do not apply any household substance or coloured ointment to the burn, and if a dressing is stuck to the wound leave it and tell the doctor. Note the exact time and mechanism of the injury and keep the name of any chemical or hot liquid involved. Report chronic conditions, particularly diabetes, weakened immunity and heart disease, list every medicine you take including blood thinners and steroids, mention drug or adhesive allergies, and give the date of your last tetanus vaccination. Take the prescribed painkiller far enough ahead of the dressing change for it to work, wear loose clothing that gives easy access to the area, and bring someone with you if the burn is on a hand or foot and stops you driving.
After the procedure
Keep the dressing clean and dry, do not wet it in the shower except in the way you were shown, and do not burst any new blisters. Elevate the injured limb to limit swelling, move the nearby joints as instructed, and take your painkiller before a dressing change rather than after it. Drink enough fluids and increase protein intake, and avoid smoking, which slows blood flow and healing. Once the wound has closed, moisturise daily and protect the area from the sun for several months, because new skin pigments very easily. Seek care immediately with **fever or chills**, **pain that increases after day three instead of easing**, **spreading redness, red streaks tracking up the limb, cloudy discharge or a foul smell**, a wound turning white or dry brown, numbness, coolness or marked swelling of the limb, or if the burn has not started improving within the timeframe your doctor gave you.
Expected duration
A dressing session usually takes 15 to 30 minutes, repeated every one to three days depending on the dressing, with superficial partial-thickness burns usually healing in two to three weeks.
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