How can I differentiate between a superficial burn and a deeper burn that may require more intensive management?

To differentiate between a superficial burn and a deeper burn that may require more intensive management, assess the burn's depth, appearance, and healing progress.

• Superficial epidermal burns (e.g., sunburn) typically present with red or pink skin without blistering and usually heal within 2–3 weeks without scarring.
• Superficial dermal burns may have blistering and redness but still generally heal within 2–3 weeks; these may require referral to physiotherapy or occupational therapy if hypertrophic scars or contractures develop.
• Deeper burns, such as full-thickness burns, often appear white, leathery, or charred, may be painless due to nerve damage, and do not heal within 2–3 weeks, indicating the need for specialist surgical management including excision and grafting.
• If a burn wound has not healed after 2–3 weeks, it suggests a deeper injury than initially assessed and warrants specialist referral.
• Burns with extensive blistering (greater than 15–25% body surface area in adults) or those involving critical areas (face, neck, joints, circumferential limbs) require more intensive management due to risks such as airway oedema, contractures, vascular compromise, or respiratory compromise.
• Systemic symptoms such as signs of heat exhaustion or heat stroke also indicate the need for urgent assessment and possible admission.

Initial assessment should include history taking and evaluation of burn severity, with attention to airway, breathing, and circulation, especially in burns involving the face or inhalation injury risk.

First aid includes immediate cooling (avoiding ice or very cold water), removal of non-adherent clothing, elevation of the injury, and covering with cling film to prevent infection and allow wound visualization.

Inadequate initial management of superficial burns may allow progression to deeper wounds.

In summary, key differentiators are the burn's appearance, presence and extent of blistering, pain level, healing time, and involvement of critical areas or systemic symptoms.

All these points guide whether the burn is superficial or deeper and the level of management required.

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