A 28-year-old woman is brought to the emergency department 2 hours after her cotton saree caught fire while cooking. She has erythematous, blistering lesions over her anterior chest, abdomen, and bilateral upper limbs. The lesions are painful, blanch on pressure, and have a moist, glistening appearance. Her vital signs are stable. What is the depth of burn in the affected areas?

Explanation

## Burn Depth Classification The clinical presentation describes a **superficial partial-thickness (2nd degree) burn**, also called a **superficial dermal burn**. ### Key Clinical Features Presented | Feature | Finding in Case | Significance | |---------|-----------------|---------------| | Appearance | Erythematous, blistering | Intact epidermis with blister formation | | Sensation | Painful | Nerve endings intact in superficial dermis | | Blanching | Yes, on pressure | Viable capillaries present | | Surface | Moist, glistening | Exudation from damaged dermis | | Healing | Implied by viability | Epithelialization from skin appendages | **Key Point:** Superficial partial-thickness burns involve the epidermis and superficial dermis (up to ~0.5 mm depth). The presence of pain, blanching, and blistering indicates viable tissue with intact sensory and vascular function. ### Differentiation from Other Depths **Deep Partial-Thickness (Deep 2nd Degree):** - Extends to deep dermis (0.5–1.5 mm) - Pale or mottled appearance (fewer viable capillaries) - Decreased sensation (nerve endings damaged) - Slower healing; higher scarring risk - Blisters may be absent or thin **Full-Thickness (3rd Degree):** - Involves entire dermis and extends into subcutaneous tissue - Leathery, charred, or white appearance - No pain (nerve destruction) - No blanching (no viable capillaries) - Requires skin grafting for healing **Subdermal (4th Degree):** - Extends into muscle and bone - Charred, black appearance - Associated with severe injury; rare in isolated burns **Clinical Pearl:** The **blanching test** (capillary refill) is the most reliable bedside discriminator: blanching = viable dermis (partial-thickness); no blanching = full-thickness. **High-Yield:** Superficial partial-thickness burns are painful and blanching; deep partial-thickness burns are less painful and may not blanch completely; full-thickness burns are painless and non-blanching. **Mnemonic: "SBFD"** — Superficial = Blistering, Blanching, Fluid-filled; Deep = Decreased sensation, Darker; Full = Firm, Fibrotic, Fixed (no blanching).