What is it?
- Burns are injuries to tissue that can be caused by fire, the sun, chemicals, heated objects or fluids, electricity, or other means. Burns can be minor medical problems or life-threatening emergencies.
- Burn treatment depends on the severity and size of the burn. You can treat most minor burns at home using first-aid measures, such as cooling the skin and applying an anesthetic cream or aloe gel to the burn. Deep or widespread burns need immediate medical attention.
- You can reduce your risk of common household burns by being prepared and taking precautionary steps, such as keeping lighters and matches out of the reach of children and checking your smoke detectors yearly.
Signs and symptoms of burns include:
- Red, swollen skin
- Pain, which may be severe
- Wet or moist-looking skin
- Waxy white, leathery or tan skin
- Blackened or charred skin, in severe cases
Burns don't affect the skin uniformly, so a single injury can reach varying depths. Distinguishing a minor burn from a more serious burn involves determining the degree of damage to the tissues of the body. The following are four classifications of burns:
- First-degree burn. This minor burn affects only the outer layer of the skin (epidermis). It causes redness and pain and usually resolves with first-aid measures within several days to a week.Second-degree burn. These burns affect both the epidermis and the second layer of skin (dermis), causing redness, pain and swelling.
- A second-degree burn often looks wet or moist. Blisters may develop and pain can be severe. Deep second-degree burns can cause scarring.
- Third-degree burn. Burns that involve the epidermis and the dermis and reach the tissue underneath them (subcutaneous tissue) are called third-degree burns. The skin may appear stiff, waxy white, leathery or tan. Third-degree burns can destroy nerves, causing numbness.
- Fourth-degree burn. The most severe form of burn reaches beyond the subcutaneous tissue and into the nerves, muscle and bones that lie beneath. The skin may appear blackened or charred. If nerve damage is substantial, you may feel no pain at all.
Burns occur when the skin is exposed to high temperatures — greater than 140 F (60 C). Many substances can cause burns, including:
- Hot liquid or steam
- Hot metal, glass or other objects
- Electrical currents
- Radiation, such as from X-rays or radiation therapy to treat cancer
- Sunlight or ultraviolet (UV) light from a sunlamp or tanning bed
- Chemicals, such as strong acids, alkalis (such as lye or cement), paint thinner or gasoline
Deep or widespread burns can lead to many complications, including:
- Local infection. Burns can leave skin vulnerable to bacterial infection, particularly staphylococcus infection, and increase your risk of sepsis, a serious infection that travels through your bloodstream and affects your whole body.
- Widespread infection (sepsis). Sepsis occurs when bacteria from an infection enter your bloodstream and spread throughout your body. Sepsis is a rapidly progressing, life-threatening condition that can cause shock and organ failure.
- Low blood volume (hypovolemia). Burns can damage blood vessels and cause fluid loss. This may result in low blood volume (hypovolemia). Severe blood and fluid loss prevents the heart from pumping enough blood to the body.
- Dangerously low body temperature (hypothermia). The skin helps control the body's temperature, so when a large portion of the skin is injured, you lose body heat. This increases your risk of hypothermia — when the body loses heat faster than it can produce heat, causing a dangerously low body temperature.
- Breathing (respiratory) problems. Breathing hot air or smoke can burn airways and cause breathing difficulties. Smoke inhalation damages the lungs and can cause respiratory failure.
- Scarring. Burns can cause scars and keloids — ridged areas caused by an overgrowth of scar tissue.
- Bone and joint problems. Deep burns can limit movement of the bones and joints. Scar tissue can form and cause contractures, when skin, muscles or tendons shorten and tighten, permanently pulling joints out of position.
As part of diagnosing a burn, your doctor will likely:
- Assess your signs and symptoms
- Examine the appearance of your skin
- Determine your recent exposure to heat or a burning substance
Evaluating your lungs
Depending on your type of injury, your doctor may also run tests to see if hot air or gases have damaged your lungs (an inhalation injury). These tests might include:
- Chest X-ray
- Endoscopy — a procedure that uses a tiny camera on the end of a long flexible tube to view the trachea and upper airway
Determining total body surface area involved
For larger or more serious burns, your doctor determines the total body surface area (TBSA) involved using one of several methods. Knowing how much of the body is burned helps your doctor determine treatment, burn care needs and recovery outlook.
One method for determining TBSA is called the rule of nines. In the rule of nines, specific areas are assigned percentage values as follows:
- Head and neck: 9 percent
- Front part of the torso: 18 percent
- Back part of the torso: 18 percent
- Arms: 9 percent each
- Legs: 18 percent each
- Pubic area: 1 percent
The rule of nines is usually modified for children because they have relatively smaller limbs and larger head sizes.
Treatments and drugs
Burn treatment depends on the severity and size of the burn.
You can treat first-degree burns and small second-degree burns at home using self-care measures, such as cooling the skin and taking pain relievers. Minor burns usually resolve within a couple days up to several weeks.
Serious burns are considered a medical emergency and require emergency medical treatment.
Seek emergency treatment for:
- Burns that are moderate, severe, or widespread
- Burns that involve your hands, feet, groin or face
While waiting for the emergency unit to arrive, follow these steps:
- Make sure the cause of the burn has been extinguished or removed. If clothing is on fire, don't let the person run — that will only feed the fire. Put out the flames with water, or wrap the person in a blanket or coat and roll the person on the ground. Ensure that the person isn't in contact with smoldering materials.
- Make certain that the burn victim is breathing. If breathing has stopped or you suspect that the person's airway is blocked, try to clear the airway and, if necessary, do cardiopulmonary resuscitation (CPR).
- Cover the area of the burn with a dry, sterile bandage, if available, or a clean cloth. A sheet will do if the burned area is large, but don't use a blanket or towel that may have fibers that can stick to the burn.
Burn treatment in a hospital usually involves the following:
- Assessment of the burn and any related conditions, such as inhalation injuries. If not already done, clothing and jewelry are removed from the burned area.
- Intravenous (IV) fluids. Doctors deliver fluids continuously through a vein (intravenously) to prevent dehydration.
- Medications. Oral or IV pain medications and antibiotics are given to reduce pain and to prevent infection. Topical medications may also be applied to the burned area to reduce pain and speed healing.
- Wound care. The burn is cleaned and embedded pieces of clothing or other debris are removed.
- Protective dressings. Depending on the size and location of the burn, the area may be wrapped with dressings or bandages to protect the skin, reduce pain, and prevent the loss of heat and moisture through the wound.
- Skin grafting. For burns that cover a large area of skin, skin grafting may be required to help skin tissue regenerate, prevent scarring and aid the healing process.
- Surgery. In severe cases, surgery may be necessary to close the wound, remove the dead tissue or treat related complications.
Depending on the severity and size of the burn, you may be referred to a specialty facility or burn care unit for specialized burn treatment.
Serious burns that cover a smaller area may heal without significant medical treatment, although they're likely to cause permanent scarring. Generally, even serious burns heal much like any other wound — a scab forms over the burned area, skin tissue regenerates and new healthy skin grows in the wounded area.
Second-degree burns can take at least two to three weeks to heal; more severe burns may take longer. Rehabilitation can take a year or more and may include reconstructive surgery (plastic surgery), ongoing wound management, and physical therapy to improve muscle strength and coordination.
To treat minor burns — first-degree burns and small second-degree burns — follow these steps:
- Make sure the cause of the burn has been extinguished or removed. Remove jewelry or clothing from around the burned area.
- Cool the burn. Put burned areas in room-temperature water — 50 to 77 F (10 to 25 C) — for 15 to 30 minutes. Don't use ice or ice water. Putting ice directly on a burn can cause the body to become too cold and cause further damage to the wound.
- Apply a lotion or moisturizer to soothe the area and prevent dryness. Try anesthetic cream or aloe gel. Don't apply butter or ointments to the burn. Both hold heat in the tissues and may cause more damage. They also increase the risk of infection.
- Cover the burn with a sterile gauze bandage. Wrap loosely to avoid putting too much pressure on the burn. Bandaging keeps air off the burn and reduces pain.
- Take an over-the-counter pain reliever unless your doctor has told you to avoid these medications. These include drugs such as aspirin, ibuprofen, naproxen and paracetamol.
- Don't break blisters. Broken blisters are more vulnerable to infection. If a blister breaks, wash with antibacterial soap and water, apply an antibiotic ointment and bandage.
Coping and support
Coping with a serious burn injury can be a challenge, especially if it covers large areas of your body or is in places readily seen by other people, such as your face or hands. Potential scarring, reduced mobility and possible surgeries only add to the burden.
Here are some ways to help you cope and feel more in control:
- Acknowledge the pain. Burns can sometimes cause chronic pain. Some people try to pretend their pain doesn't exist. In the process, they may actually make it worse. You may have more success in coping if you affirm that your pain isn't imaginary and make necessary adjustments to accommodate it.
- Get educated. Find out as much as you can about what to expect during recovery. Educate those around you — including family and friends — so they can recognize, acknowledge and support your efforts in dealing with the burns.
- Find a support group. Consider joining a support group with other members who have had serious burns and know what you're going through. You may find comfort in sharing your experience and struggles and meeting people who face similar challenges. Ask your doctor for information on support groups in your area or online.
To reduce your risk of common household burns:
- Never leave items cooking on the stove unattended.
- Turn pot handles toward the rear of the stove.
- Use sturdy oven mitts that cover hands and wrists.
- Keep hot liquids out of the reach of children and pets.
- Never cook while wearing loosefitting clothes that could catch fire over the stove.
- Keep space heaters away from combustible materials.
- If you must smoke, avoid smoking in the house and especially never smoke in bed.
- Check your smoke detectors and change their batteries yearly.
- Keep chemicals, lighters and matches out of the reach of children.
- Set your water heater's thermostat between 120 and 130 F (49 to 54 C) to prevent scalding.