Deep dermal burns are characterised by the early (within hours) development of extensive blisters, which usually rupture early to expose deep damaged dermis. The exposed reticular dermis may be pale in colour due to damage to dermal blood vessels, or red due to extravasation of red blood cells from damaged vessels.
The hallmark of these types of burns is greatly diminished capillary return, with no or sluggish blanching when pressure is applied to the wound bed. This is a result of the extensive destruction of the dermal vascular plexus. The dermal nerve endings are also damaged and so sensation is reduced. These deeper burns tend to be dry, with diminished fluid exudates compared with more superficial burns.
Following first aid and cleansing, deep dermal burns should be covered with an appropriate silver or antibacterial dressing and referred to a surgeon for surgical management.