Burns are a common type of skin injury. People can receive burns from a number of thermal (e.g., steam), electrical (e.g., powerline), chemical (e.g., lye) and radioactive (e.g., sunburn) sources. Most burns are caused by scalds, building fires and flammable liquids and gases.
The skin is composed of three layers. The outermost layer of skin is known as the epidermis. Located below the epidermis is the dermis, the middle layer of skin. The bottom layer of skin is known as subcutaneous tissue. This layer mainly consists of fat.
The severity of a burn can range from minor, affecting only the top layer of skin, to severe. In addition to damaging all layers of the skin, severe burns can also injure other parts of the body including muscles, bones and nerves. The severity of a burn is based on several factors, including:
- Depth of the burn. Depending on how many layers of skin are affected, a burn will be classified as first, second or third degree.
- Size of the burn. A burn larger than the size of a person’s palm requires a physician’s attention.
- Location of the burn. The major joints, hands, feet, face, genitalia and buttocks are considered critical areas.
- Patient’s age. Even small burns can be dangerous for young children and the elderly.
- Overall health of the patient. Having certain existing conditions (e.g., diabetes) can cause further complications in a burn injury.
- Source of the burn. Certain sources, such as electricity and chemicals, can complicate a burn injury.
According to the American Burn Association (ABA), there are more than 1 million burn injuries each year in the United States. Most burns are minor injuries requiring minor first aid. However, many burns require serious medical treatment. Approximately 45,000 hospitalizations a year are due to burn injury, according to the ABA. In addition, there are about 4,500 fire and burn deaths per year. Infants and the elderly are at the greatest risk for burn injury.
The depth and severity of a burn can vary. This information is used to classify burns into three categories:
The least serious type of burn. It involves only the epidermis (the outer layer of the skin). The burn site is painful and appears red, dry and absent of blisters. The injured area slightly swells and turns white when pressed on. The skin over the burn may peel off after one or two days. Mild sunburn is an example of a first degree burn. This type of burn is also known as a thin or superficial burn.
Involves the epidermis and the dermis (the layer beneath the epidermis). The burn site is painful and appears red and blistered. Swelling may also occur. This type of burn is also known as a superficial partial-thickness or deep partial thickness burn.
Involves damage or total destruction of all three layers of the skin – the epidermis, dermis and subcutaneous layer. Underlying muscles, tendons and bones may also be damaged. The injured skin appears white or charred black. The patient may feel little pain or no pain at all in the area since the nerve endings are often damaged. This type of burn is also known as a full-thickness burn.
Burns are often further classified by severity into three categories – minor, moderate and severe. In order to determine this classification, physicians estimate the percentage of the body surface that has been burned. Estimating the total area of the burn is significant because it enables physicians to predict how well the burn will heal, as well as determine the likelihood of complications. Physicians use charts to help them estimate the percentage of burnt area. An adult arm, for example, comprises approximately 9 percent of the body.
Burns can be caused by a number of sources including thermal, electrical, chemical and radioactive agents. Burns are often classified by the source of the injury:
- Thermal burns. Burns caused by external heat sources such as hot metal, scalding liquids, steam and flames. When the skin is exposed to these sources of heat, the temperature of the skin and tissues increases, resulting in death of the tissue cells. The majority of burns are thermal burns. Among adults, the leading cause of burn injury is flame. The majority of burns among children are caused by scalding.
- Radiation burns. Burns caused by prolonged exposure to sources of radiation, including the ultraviolet radiation of the sun and x-rays.
- Chemical burns. Burns caused by potent acids or alkaloids coming into direct contact with the skin. Caustic substances are found in many household products including those containing lye (e.g., drain cleaners, paint removers), phenols (e.g., deodorizers, sanitizers, disinfectants), sodium hypochlorite (e.g., disinfectants, bleaches) and sulfuric acid (e.g., toilet bowl cleaners).
- Electrical burns. Burns resulting from contact with an alternating current, such as open wiring or a lightning strike.
- Red skin
- Peeling skin
- White or charred skin
Patients with severe burns may also develop a life-threatening condition known as shock. This may result from dehydration (via fluid loss through open wounds) and/or decreased blood flow.
- Clammy skin
- Bluish fingernails or lips (cyanosis)
- Reduction in alertness
Diagnosis is based on the appearance of the burn. Different degrees of burns have different characteristics.
In general, first degree burns are typically red, dry, swollen and painful. The area usually blanches (whitens) when it is lightly touched. First degree burns do not blister.
Second degree burns are also red, swollen and painful and may be moist. The area may also blanch when touched. Unlike first degree burns, however, second degree burns usually develop blisters that may ooze a clear liquid.
Third degree burns are usually not painful because the nerves are often destroyed. The skin appears leathery and may be white, black or bright red in color. The affected area does not blanch when touched and blisters do not develop.
Accurate classification of the degree of burn is not always possible at the initial diagnosis. Revisions may be necessary later.
Minor burns often heal well on their own and do not require serious medical treatment.
First aid, however, should be administered for all types of burns. Before first aid begins, the depth of the most serious part of the burn should be determined. The burn should then be treated accordingly. People who are uncertain of a burn’s severity should treat it as a major burn.
Although uncommon, dehydration sometimes results from fluid loss related to a burn. Patients exhibiting signs of dehydration, such as thirst, dry skin, dizziness, lightheadedness and decreased urination after a burn should seek immediate medical attention.
- Apply cool water. If the affected skin is unbroken, cool water should be applied to the burn. The area of the burn can be soaked in cool water or cool water can be poured over the area. If possible, the area should be submerged in the water for at least five minutes. A clean towel that is wet and cold can also be used to reduce pain if the area of the burn is very small. Do not use ice on the burn.
- Apply an antibiotic ointment.
- Place a dry gauze bandage over the burn.
- Avoid placing pressure or friction on the burn site.
- Take over-the-counter pain medication (e.g., acetaminophen, ibuprofen) to relieve pain and reduce swelling.
- If desired, patients can also apply moisturizing lotion or aloe vera to the area once the skin has cooled and is completely dry.
In addition, patients with minor burns who are not up-to-date on their tetanus (bacterial infection) booster may require a shot. Most physicians recommend receiving a tetanus shot once every ten years.
Second degree thermal and radiation burns that cover an area of skin more than 2 to 3 inches (8 centimeters) in diameter are considered major burns. Second degree burns on the hands, feet, face, groin, buttocks or a major joint are also considered major burns. It is important to administer first aid to major burns before professional medical help is sought because doing so can lessen the severity of a burn. It may also prevent complications such as scarring, disability and deformity.
- Call for emergency medical help, if:
- The burn is the size of a palm or larger
- The burn is a third degree burn
- The person displays signs of shock (e.g., paleness, bluish fingernails or lips)
- Make sure the patient is no longer in contact with smoldering materials. Jewelry and clothing near the burn area should also be removed promptly because burned areas swell quickly. Any clothing stuck to the skin, however, should not be removed.
- Make sure the patient is breathing. If necessary, begin cardiopulmonary resuscitation (CPR).
- Cover the burn. A dry, sterile nonstick dressing, such as a bandage or clean cloth, should be used to cover the burn. Gauze or tape can be used to keep the dressing in place. A clean sheet can be used if the burn site is large. If fingers or toes have been burned, dressings should be used to separate them.
- Elevate the area of the burn. The burn area should be elevated above the level of the heart, if possible.
- Avoid pressure and friction. The area of the burn should be protected from pressure and friction.
- Prevent shock. The burn victim should lay flat with their feet elevated about 12 inches (30 centimeters). A blanket or coat should also be placed over the patient. People should not be placed in this position, however, if a head, neck or back injury is suspected. The position should also be avoided if it causes discomfort.
- Monitor vital signs. The patient’s pulse, rate of breathing and blood pressure should be monitored until medical personnel arrive.
Severe burns should not be placed in cold water. Doing so can cause shock, a life–threatening condition that occurs when not enough blood flows through the body. Patients should also avoid putting ointment, butter, oil, ice, medications or cream on severe burns. Doing so can potentially cause additional damage to the skin. In addition, people should avoid breathing, coughing or blowing on the burn.
Electrical burns are treated differently than other types of burns. People suffering from an electrical burn should always seek immediate medical treatment, even when there is no evidence of injury on the skin. This is important because electrical burns can result in serious injury inside the body. When burned areas are present on the skin, they should be quickly covered with a sterile gauze bandage or clean cloth.
Chemical burns are also treated differently.
- Remove the source of the burn from the skin. Flush the area with cool water for a minimum of 20 minutes. If the chemical is in a powder form, brush it off the skin before running water over the area.
- Remove any clothing or jewelry with traces of the chemical on it.
- Cover the area. A dry sterile dressing or clean cloth should be wrapped around the area of the burn. Avoid putting ointments or any other substance on the burn site. Doing so could trigger a chemical reaction that makes the burn worse.
If patients experience increased pain, they can either rinse the burn again or apply a cool wet compress to the site. Minor chemical burns usually heal well on their own without further medical treatment. However, emergency medical treatment should be sought when:
- The victim shows signs of shock, including fainting, paleness or shallow breathing
- The burn is a second degree burn covering more than 2 to 3 inches (5 to 8 centimeters) or a third degree burn
- The burn is located on the eye, hand, foot, face, groin, buttocks or a major joint
- Setting the temperature of the water heater to 120 degrees Fahrenheit (49 degrees Celsius) or less (or the “low-medium” setting)
- Testing the water temperature before stepping into a shower or bath
- Teaching children not to touch faucet handles during a bath
- Installing smoke alarms and testing the batteries weekly
- Knowing the fire escape routes at home, work and school
- Placing fire extinguishers in strategic locations in the home (and knowing how to use them)
- Keeping pot handles turned toward the side or the back of the stove, or using the back burners
- Not leaving pots and pans unattended while cooking
- Teaching children about fire safety and the dangers of matches and fireworks
- Teaching children not to climb on the stove or play near the stove
- Teaching children not to grab potentially hot objects (e.g., oven door, iron)
- Not wearing long, loose sleeves when cooking
- Not smoking in bed
- Disposing of used cigarettes carefully
- Placing safety screens around fireplaces, wood burning stoves, space heaters, baseboard heaters and radiators
- Having chimneys and fireplaces professionally inspected once a year
- Storing matches and lighters out of the reach of children
- Keeping lit candles out of the reach of children
- Using a cool mist humidifier or vaporizer, rather than a steam model
- Keeping hot drinks and food out of the reach of children and not carrying hot liquids and dishes near a child
- Testing the temperature of food and hot drinks before serving them to a child
- Checking the temperature of playground equipment (e.g., metal slide) before allowing a child to play near it
- Checking the temperature of car seats and strollers before placing a child in them
- Wearing sunscreen whenever spending time in the sun
- Following the manufacturer’s directions and recommended safety precautions
- Storing all chemicals out of the reach of children
- Wearing safety clothing, such as gloves and eye goggles
- Place safety covers on electrical outlets within the reach of children
- Use three pronged electric outlets (the safest type of outlet)
- Ensure all electrical devices are installed and serviced by properly licensed people
- Ensure that any electrical device that touches or may be touched by the body is properly grounded
- Replace frayed, brittle or otherwise damaged electrical cords
- Have the wiring in their home inspected by a professional electrician at least once every 10 years
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following burn-related questions:
- What degree is my burn? What is the difference between first, second and third degree burns?
- How long will my burn take to heal?
- Will my burn leave a scar?
- How should I care for my burn while it is healing?
- What can I take to relieve the pain?
- What first aid steps should I take for a burn?
- When should I seek emergency medical treatment for a burn?
- Am I at risk for any complications?
- How will I know if my burn becomes infected?
- Do I require a tetanus shot?
- To treat minor burns, you may use non-prescription antibiotic ointments, topical anesthetics and aspirin.
- To treat severe burns, pain relievers, antibiotics and tetanus booster shots may be required.
Depends on location and extent of the burn. Getting a burn patient up and moving as soon as possible after treatment begins is an important part of the recovery.
No special diet for minor burns. More severe burns require intravenous feeding.
- You or a family member has been burned. This can be an emergency.
- An infant has a burn, even if it seems minor.
- The following occur during treatment: No healing in 6 days; chills and fever; increased pain, redness, swelling or pus in the burn area.