How to Recognize and Treat 6 Degrees of Burns

Updated on February 20, 2018
Patty Inglish, MS profile image

Ms. Inglish uses her medical and health psychology experience to serve clients through the American Red Cross and church-based clinics.

Burn percentage chart by body region for adults and children.
Burn percentage chart by body region for adults and children. | Source

The Six Degrees of Burns

First-Degree Burns

A first-degree burn after one day.
A first-degree burn after one day. | Source

These first-level burns include reddened skin and burning through the top layer or top few layers of skin, with some swelling but without blistering. They can be painful. If they cover a large area, then see your doctor for help.


According to the American Red Cross, small burns of this level can be treated with cool water or a cool compress. Electrical burns need a doctor's attention. If any burn becomes infected, see a physician.

You may possibly use a lidocaine spray to relieve pain or apply aloe vera, honey, lotion, or antibiotic ointments. Never use any kitchen oil or butter on a burn because they actually prevent healing.

Second-Degree Burns

A second-degree burn.
A second-degree burn. | Source

These include reddened skin and raised blisters that should not be popped open, because of infection risks. See a doctor.


Second-degree burns can be examined by a physician, and the blisters are handled according to their best practices. You may receive a prescription for antibiotic ointment and gauze wrapping.

Third and Fourth-Degree Burns

Eight-day-old third-degree burn on the foot.
Eight-day-old third-degree burn on the foot. | Source

In the third and fourth degree, bones may be damaged without charring. However, these burns may damage bones enough to disable a patient and, in some cases, may lead to death. Professional treatment is necessary. More extensive tissue damage exists in the fourth degree than in the third degree.

These two levels of injury usually result from prolonged exposure to fires, chemicals, or very hot liquids. Children and adults can be badly scalded and further burned by hot bath water or hot soup on a stove.


Third and fourth-degree burns are professionally cleaned and dressed when the patient reaches a hospital. Since these burns cause fluid loss, especially with 60% of the body burned as mentioned above, IV solutions are required to replace lost fluids and reduce the risk of complications.

In these burns, some tissue under the skin is also lost. Children's hospitals often maintain dedicated Burn Centers in which burn victims can receive the needed round-the-clock care by specialists.

Debridement after the initial treatment is the scrubbing away of dead skin, usually causing severe pain and much screaming. New methodologies are being developed that can reduce this level of pain, but they are not yet mainstream.

One method, developed in a clinic in Mexico, uses super-oxidized water and hydrotherapy to remove dead tissue and was developed in a clinic in Mexico. Some countries use fish skin to cover healing burns. Other specialists recommend hyperbaric oxygen treatment as an adjunct to speed healing with additional oxygen. Research is underway to develop more effective and less painful burn treatments.

Some cases require surgical removal of dead skin and underlying tissues, followed by skin grafting, a surgical procedure in which skin is transferred from the thigh or buttock and sewn over a cleaned burn. Some of the worst cases may require amputation of body parts.

Fifth-Degree Burns

Fourth and fifth-degree burns.
Fourth and fifth-degree burns. | Source

The only difference between the two worst burn categories (fifth and sixth degree) is that the fifth-degree burn does not include charred bone.


The damage from these burns are too extensive and rarely respond to debridement and grafting.

Sixth-Degree Burns

Cross-section of human skin showing all layers. The 5th and 6th-degree burns damage all of these tissues and continue to the bone.
Cross-section of human skin showing all layers. The 5th and 6th-degree burns damage all of these tissues and continue to the bone. | Source

Generally, by the time a body part burns to the sixth-degree, all tissues—from the outer skin layer (epidermis) down to the bone—are irrevocably damaged, and the bone itself is charred black.


Currently, no treatment exists for this level of damage.

This wooden log is charred through and through. The bones after a 6th-degree burn looks much the same.
This wooden log is charred through and through. The bones after a 6th-degree burn looks much the same. | Source

The Worst Burns Do Exist

The two highest degrees of burns are not commonly mentioned because they rarely occur. They have mostly been used as specific medical pathology terms in autopsies of burned bodies, the highest level being similar to cremation. Attorneys often cite fifth and sixth-degree burns as found in autopsy reports used for legal actions. Anecdotal denials of the existence of the final two degrees may stem from a lack of knowledge of such pathology.

Uses of Fifth and Sixth-Degree Burns

These two degrees may have previously been limited to radiation victims of the historic Hiroshima and Nagasaki nuclear attacks, the radiation events of Soviet submarines like the K-19 in the 1960s, and in the Chernobyl disaster.

Future advances in modern weapons of war and aerospace technologies may require these final two burn degrees to be more widely used.

A common misconception is that there are only three degrees of burns. The reality is there are six; however most people will not survive burns past the fourth degree.

— DOCCS/Diagnostic and Clinical Care Services of Brevaerd County, FL

Novel Treatments

The Pig Matrix of New Skin

Interestingly, fictitious medical procedures from Star Trek® resulted in stimulating research that produced an artificial skin. Today, that artifice can be laid over well-cleaned burn areas instead of using bandages. The body heals around it, after which, it dissolves.

Another technique involves the use of powdered pig-tissue matrix. It can be placed on human tissues to encourage new tissue growth at the site. This includes muscle, bone, an esophagus, skin, and many other types of tissue. In still other methods, a patient's own stem cells have been used to grow new skin.

Wound Dressings

Dressings and bandages are typically used to cover burns in order to help the body maintain its normal heat and to resist infection. In the 1980s, a child in our Cincinnati Children's Hospital Burn Unit was hypnotized to raise his second-degree-burned arms in front of him at shoulder height and maintain them there without tiring. This technique worked for him for two important weeks and resulted in fewer bandages needed. His arms did not rub against his body to aggravate the damage, and he felt less pain. Overall, when the wound is left alone, healing is quicker.

Extreme Care Needed

With third-degree burns, skin grafting and more extensive plastic surgery are often needed. These procedures may take up to several years to complete.

Infections can be a long-standing problem. Amputations are still sometimes necessary, and the fitting of prostheses can take prolonged periods of time and require help with funding.

Severely burned children are often supported in their home communities with fundraising events sponsored to provide money in the absence of adequate insurance coverage.

The Severity of Burn Injuries

An extensive burn injury is one of the most painful types of damage that the human body can suffer and in children, it is heartbreaking. In a house fire, the screams of a burning child that cannot be found are haunting. The screams of agony from a child in a hospital burn unit undergoing the scrubbing away of dead and burned skin with metal brushes is nerve-shattering.

The skin grafting surgeries are lengthy, often taking months or years. Not all grafts are successful. Not all plastic surgeries can save a 2-year-old's twisted, scarred face that may no longer have a nose or ears. Fingers heal together or are burned off. Feet sometimes become charred stumps. Limb amputation sometimes becomes necessary, even in the truth of all this, the public hopes for the newest technologies to come to the rescue in these cases.

In the 2010s, fire prevention is still many times more effective than any treatment of third-degree burns.


The little girl was just three years old.

On the Friday before Palm Sunday, her teen brother was watching her, her four-year-old sister, and the dogs. The mom, dad, and a middle-school sister were away. Suddenly, a fire broke out upstairs in the two-story home. The brother saved the 4-year-old and the dogs but was cut-off from the youngest child by the fire.

He stood on the sidewalk screaming for help. A passerby jumped from his car and entered the house, heard screams, but could not navigate through the flames.

The fire department arrived; one of the men was burned, himself, as he extracted the youngest victim from the second-floor inferno.

She was rushed to the children's hospital 100 miles away, where she was diagnosed with third-degree burns over 60% of her body. Her mom, dad, and sisters moved into a Ronald McDonald House next door but sat by her hospital bed most of the time. Her brother went to another city to stay with a friend.

What caused the fire on the second floor? It could have been an electrical wiring problem in the rental property that also had an unfinished basement with only a dirt floor; building codes may not have been met in other ways. The struggling family in Michigan had to find a new residence.

Shriner's Hospitals are famous for their pediatric burn units.
Shriner's Hospitals are famous for their pediatric burn units. | Source

Landlord Responsibilities

Landlords that own rental properties such as houses, apartments, converted garages, and other residences have the responsibility to provide fire-safe living arrangements according to the law.

Smoke detectors must be installed in these residences, checked at least yearly, and maintained in workable condition at all times. Electrical wiring throughout the building in these residences must be up to code according to legal standards.

Playing with matches and candles changed a 3-year-old's life. At age 10 in 2017, she was still undergoing plastic surgery treatments.
Playing with matches and candles changed a 3-year-old's life. At age 10 in 2017, she was still undergoing plastic surgery treatments. | Source

Sixty-percent body coverage by third-degree burns in a three-year-old is serious. All layers of the skin are burned through across more than half of the body, leaving the patient open to infection, dehydration, shock, the possible need for a tetanus shot, and in extreme cases, loss of limb(s) and face. Fat, muscle, and other elements beneath the skin may also be damaged.

A fourth-degree burn includes fire damage below all layers of skin and into the muscle, tendons, and ligaments. This damage creates a carbonized appearance similar to charcoal.

Persons struck by trains have been carbonized throughout their bodies with these burns and have been subjects of an old traffic safety film, Signal 30.


Call your local Red Cross for additional information and first aid training. Call or visit your healthcare professional or hospital for burns above the first-degree and even for first-degree damage covering large areas of the body.


  • American Red Cross First Aid Training.
  • n.a. (October 2013). Burns. MedLine Plus at the US National Library of Medicine. Retrieved June 5, 2017.
  • Inglish, Patty: First hand witness to Dreffs Family fire disaster and aftermath in Bay City, Michigan from April 15, 2011 to the present.
  • Memory Alpha, Star Trek® Fandom. Retrieved June 6, 2017.
  • Morgan, Walker. Fourth, Fifth & Sixth Degree Burns. Retrieved May 10, 2016.
  • Ohio State Highway Patrol and the Highway Safety Foundation. Signal Thirty. 1959.

© 2011 Patty Inglish


    0 of 8192 characters used
    Post Comment

    • profile image

      solex 6 years ago

      please can any one give me advice on how to help a young lady treat a childhood burn that has partially disfigured her left hand. It appears toe to be a third degree burn caused by her dipping her hand into hot oil on a frying bowl when she was rather too young. To fully describe the appearance her hand the skin on the left hand is slightly dis-colored and there is a partial web between four fingers. Thanks anybody

    • LailaK profile image

      LailaK 6 years ago from Atlanta, Georgia

      Your hub is very informative and practical! Thanks for sharing!

    • dusy7969 profile image

      dusy7969 6 years ago from San Diego, California

      I get the lot of information about the treatment of burn.Thanks for this hub.I agree with Cobranurse you say right.We should not leave the children alone in the house.Thanks for this informative and useful sharing.

    • Support Med. profile image

      Support Med. 6 years ago from Michigan

      Glad she's alive - so sad - I have a family member who's retired from the Fire Department - stories can be heartbreaking-and it seems city officials do not give them the support and credit they deserve. v/r

    • Hello, hello, profile image

      Hello, hello, 6 years ago from London, UK

      Thank you, Patty, for such a really interesting and onfirmative hub. Also useful because you never know when it is needed and can save lives or more damage.

    • Patty Inglish, MS profile image

      Patty Inglish 6 years ago from USA. Member of Asgardia, the first space nation, since October 2016

      Thanks for your comment, Cobranurse. It stunningly dangerous to leave very young ones unattended and asking teens to watch more than one is hard. A third young child is now said to have been in the house as well - 3 is too many for a teen to watch along with dogs and cats on two different floors.

    • profile image

      Cobranurse 6 years ago

      Good day to you Patty!...I'm amazed on your topic and now i'm aware that you cannot leaved the children alone in the house.

    • L.L. Woodard profile image

      L.L. Woodard 6 years ago from Oklahoma City

      The Shriner's Hospitals do wonderful work with young burn victims. It would be great if those services were no longer needed, but good to know they are there when needed.

    • Patty Inglish, MS profile image

      Patty Inglish 6 years ago from USA. Member of Asgardia, the first space nation, since October 2016

      Thanks for taking the time to read and comment, KKG!

      I had only one burn, associated with restaurant work - a small steam plate boiler exploded on my leg (only 1st degree because I jumped back). Ice helped a lot, but I had an odd discoloration for months until I heard to put witch hazel on it - that worked. What they will have to do with Ally, I am not yet sure. She's in critical condition, but alive.

    • KoffeeKlatch Gals profile image

      Susan Haze 6 years ago from Sunny Florida

      Patty, I can only imagine the agony that accompanies a 3rd degree burn. For a child to have to endure this is unthinkable. I had hear a little about 4th degree burns, not much. But I never knew about 5th and 6th degree burns. As always, well-written and incredibly informative. Rated up and awesome.

    • Patty Inglish, MS profile image

      Patty Inglish 6 years ago from USA. Member of Asgardia, the first space nation, since October 2016

      Thanks for taking the time to read this one, kashmir56. I appreciate your concern!

    • kashmir56 profile image

      Thomas Silvia 6 years ago from Massachusetts

      Hi Patty thanks for all this great and valuable information,doing the right treatment for any burns is very important !

      Awesome and vote up !!!