Burn Depth Classification: Superficial vs Partial Thickness vs Full Thickness — Appearance, Pain, Healing
A burn patient screaming in pain likely has a more survivable injury than the one who feels nothing. Full-thickness burns destroy nerve endings — painless and leathery — yet they're the ones requiring surgical grafting. Mixing up depth means mistriaging who needs the OR and who needs wound care.
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- Epidermis only
- Dermis intact
- Epidermis + upper (papillary) dermis
- Epidermis + deep (reticular) dermis
- Epidermis + entire dermis
- Red, dry (classic sunburn)
- Pink-red, moist, glistening
- Mottled red/white, waxy areas
- ★Leathery, charred, or white
- None (epidermis intact)
- ★Fluid-filled blisters
- Blisters rare or ruptured
- Wound bed variable
- None — skin too destroyed
- Mild pain (sunburn)
- ★MOST painful — exposed nerve endings
- Pressure sensation only
- Less pain than superficial partial
- ★Painless — nerve endings destroyed
- Blanches, brisk refill
- Blanches, brisk refill
- Sluggish or absent blanching
- No blanching — thrombosed vessels
- Heals 3–5 days
- No grafting needed
- Heals 1–3 weeks
- No grafting needed
- Heals 3–8 weeks
- May need grafting
- Will not heal — needs excision + graft
Superficial
- Epidermis only
- Dermis intact
Superficial Partial
- Epidermis + upper (papillary) dermis
Superficial
- Red, dry (classic sunburn)
Superficial Partial
- Pink-red, moist, glistening
Superficial
- None (epidermis intact)
Superficial Partial
- ★Fluid-filled blisters
Superficial
- Mild pain (sunburn)
Superficial Partial
- ★MOST painful — exposed nerve endings
Superficial
- Blanches, brisk refill
Superficial Partial
- Blanches, brisk refill
Superficial
- Heals 3–5 days
- No grafting needed
Superficial Partial
- Heals 1–3 weeks
- No grafting needed
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More pain means more superficial — painless, leathery, and white means full thickness and the OR.
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