A burn is damage to the skin and sometimes to the underlying tissues. Burns are categorized according to the depth and extent of the damage to the skin:
Superficial burn (also called first-degree burn)
- Mildest type of burn
- Often caused by ultraviolet light, or very short (“flash") flame exposure
- Affects only the outer layer of the skin (epidermis)
- Normally does not cause scarring
- Takes about 3-6 days to heal
Superficial partial-thickness burn (also called second-degree burn)
- Often caused by a scald (spill or splash) or short (“flash”) flame exposure
- Affects the outer layer of the skin more deeply, usually causing blistering
- May or may not cause scarring, but often does cause long-term skin color changes
- Takes about 1-3 weeks to heal
Deep partial-thickness burn (also called second-degree burn)
- Often caused by a scald (spill), may involve flame, oil, or grease
- Affects the outer and underlying layer of skin (dermis), causing blistering
- Usually causes scarring
- Usually takes more than three weeks to heal
Full-thickness burn (also called third-degree burn)
- Very serious
- Often caused by scald (immersion), may involve flame, steam, oil, grease, chemicals, or high-voltage electricity
- Damages all layers of the skin, and may involve the tissues underneath (muscle and bone)
- Causes scarring
- Will heal only at the wound edges by scarring, unless skin grafting is done
Classification of Skin Burns
Burns can be caused by:
Heat or flame (thermal burns)
- Hot foods or drinks such as boiling water, tea, or coffee
- Hot oil or grease
- Hot tap water
- Direct heat such as stoves, heaters, or curling irons
- Direct flame
- Flammable liquids such as gasoline
Chemicals (chemical burn)—strong acids or strong bases such as:
- Cleaning products
- Battery fluid
- Pool chemicals
- Drain cleaners
- Sunlight ( sunburn]]> )
- Damaged electrical cords
- Electrical outlets
- High-voltage wires
- Radiation (radiation burn)
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for burns include:
- Age: less than four years
- Sex: male
- Low socioeconomic status
- Alcohol use
- Illegal drug use
- Absent or non-functioning smoke detectors
- Substandard or older housing
- Unsupervised or improperly supervised children
- Using tap water hotter than 120°F
Burn symptoms and signs vary depending on the type of burn.
- Burned area turns red and is painful
- The area blanches (turns white) when you press on it
- The area may swell, but it is dry and there is no blistering
Superficial Partial-Thickness Burn
- The area is moist, red, and weeping
- The area blanches (turns white) when you press on it
- Painful to air and temperature
Deep Partial-Thickness Burn
- Blisters, usually loose and easily unroofed
- The area can be wet or waxy dry
- The skin color can vary from patchy, to cheesy white, to red
- The area does not blanch (turn white) with pressure
- May or may not be painful, can perceive pressure
- Skin can appear waxy white, leathery gray, or charred and blackened
- May not be painful if nerves have been damaged, the only sensation may be to deep pressure
The doctor will ask how the burn occurred and will examine the burned area.
Treatment will depend on the cause of the burn, how deep the burn is, and how wide an area of the body is covered. Doctors have methods and charts to estimate the total percentage of body surface area (TBSA) affected by the injury. This estimate is age dependent; for example, the head represents a larger percentage of surface area in a baby than in an adult.
Treatment for a burn depends on the cause. Quick treatment is important and can lessen the damage to the tissues. First aid for minor burns may involve:
- Cooling the burn with running water or a cold damp cloth. Do not use ice—this may result in more damage to the skin.
- Do not use butter, grease, oils, or ointments on the burn.
- Cover the burn with sterile gauze or a clean cloth.
- Do not use a fluffy cloth such as a towel or blanket.
- Take an over-the-counter pain reliever, like acetaminophen]]> (Tylenol).
- Do not break or pop any blisters. This may result in an infection.
If you see signs of infection, get medical attention. Signs of infection include:
- Increased pain
- Oozing of pus
Once a minor burn is completely cooled, you can consider using a fragrance-free lotion or moisturizer to prevent drying and make the area more comfortable.
For more serious burns, like deep partial-thickness or full-thickness burns, seek medical attention or call 911. Until an emergency unit arrives:
- Do not take off any clothing that is stuck to the burn.
- Make sure the victim is not near or in contact with any smoldering materials, or exposed to further smoke or heat.
- Do not soak the burn in water, but you can cover the area with a cool, moist sterile bandage or clean cloth.
- As with any severe injury, make sure the person is breathing and administer ]]>CPR]]> if necessary.
If you are diagnosed with more than a minor burn, follow your doctor's instructions .
A doctor will decide if hospitalization is necessary based on many factors. These include age, the cause of the burn, and the extent and depth of the burn. Reasons to hospitalize a person who has more than a minor burn may include:
- Age: younger than five years or older than 55 years
- Suspected child abuse
- Very small, deep burns on the hands, face, eyes, feet, or perineum (groin/genital area)
- Extensive burn: using TBSA and age charts
- Burns that may require complicated dressing changes, elevation, or continued physician observation
- High-voltage injury or burn
- Suspected or known inhalation injury
- Circumferential burn
- Other medical problems that predispose a person to infection, such as:
Medical Treatment for Major Burns
If the burn is serious, the following treatments may be administered in a hospital:
Most burns are the result of accidents. To prevent burns:
- Teach children]]> about fire prevention and keep dangerous materials out of reach.
- Make sure smoke detectors are installed and in working order. Replace batteries twice a year. (One way to remember to do this is to change batteries the same days you change the clocks for daylight savings time.)
- When cooking, keep pot handles turned toward the back of the stove.
- Supervise young children in the kitchen and around fireworks.
- Set the temperature on the water heater to less than 120°F and test the bath water before your child gets in.
- Make sure children’s sleep wear is flame-retardant.
- Don’t hold children in your arms or lap while cooking, serving, or eating hot foods or liquids.
- Do not leave matches, lighters, candles, or burning cigarettes unattended.
- Wear protective gloves and clothing when handling caustic chemicals.
- Put protective covers on electrical outlets.
- Do not wear loose-fitting sleeves while cooking.
- Keep children and pets away from the stove while cooking.
- Make sure electrical cords are not hanging over the edge of countertops.
- Store chemicals and cleaners in a locked cabinet.
- Children younger than one year can sustain partial-thickness burns from hot seat belt straps or buckles in car seats. Make sure car seats are not hot before putting a child in the seat. If you park in the sun, cover the seat with a towel.
American Burn Association
Shriners Hospital for Children
Canadian Burn Foundation
Beers MH. The Merck Manual of Medical Information . 2nd ed. London, England: Simon and Schuster, Inc; 2003.
Child safety: how to prevent burns. Mayo Foundation for Medical Education and Research website. Available at: http://www.mayoclinic.com/health/child-safety/CC00044 . Updated February 2009. Accessed July 22, 2009.
Parenting corner Q&A: burns. American Academy of Pediatrics website. Available at: http://www.aap.org/publiced/BR_FireSafety_Burns.htm . Updated September 2007. Accessed July 22, 2009.
Protect the ones you love: burns. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/SafeChild/Fact_Sheets/Burns-Fact-Sheet-a.pdf . Accessed July 22, 2009.
Shriners Hospital for Children website. Available at: http://www.shrinershq.org/ . Accessed July 22, 2009.
Taking care of burns. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20001101/2029ph.html . Updated November 2000. Accessed July 22, 2009.
Last reviewed September 2009 by ]]>Ronald Nath, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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