A triple-degree burn

By Richard P. Holm, M.D.


She was removing the pan of hot grease from the stove when she spilled the stuff all over her right hand. One area of skin was just red like sunburn, which is defined as a first-degree burn. Another spot blistered making that burn second-degree. But in the center there was a third-degree burn where the grease had injured both the outer and inner layer of skin so severely it caused, eventually, a small open ulcer. Fortunately there was no fourth-degree burn, which is when the muscle and connective tissue below the skin is also injured.

She ran cool water on it for 10 minutes, and then came to see me in the clinic. I removed the dead skin gently where blisters had broken, applied antibiotic ointment with silver and sulfa, and a cotton gauze dressing to the injured skin, and prescribed pain medicine. She was instructed to protect the wound, gently wash and redress it twice daily, cut away dead skin but not break the intact blisters, just let them break by themselves, and watch carefully for infection. I set an appointment for her to see me in a few days.

I have had the experience of treating burns that were so severe that the nerve endings were destroyed and there was little pain. More common however, is the unrelenting pain associated with less-severe burns, and that was the case with our hot grease injury. The wound looked good and healed nicely over time, but she and I were challenged dealing with her pain until thankfully it resolved after a several weeks.

The skin is the largest organ of the body and it weighs six to nine pounds. It spreads a thin-but-important layer over the outside of our body, protecting us from invading bacteria and viruses, managing fluid balance, controlling body temperature, and allowing for sensations that include touch, pressure, heat, cold, and especially pain.

It shouldn’t take a burn to realize the value of our skin.

Dr. Rick Holm wrote this editorial for “On Call®,” a weekly program about health on South Dakota Public Broadcasting-Television that is produced by the South Dakota Cooperative Extension Service. “On Call” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain