Burns

Overview

Burns are tissue damage that results from too much sun, hot liquids, flames, chemicals, electricity, steam and other sources. Burns can be minor medical problems or life-threatening emergencies.

The treatment of burns depends on where they are on the body and how bad they are. Sunburns and small scalds can often be treated with first aid. Deep or widespread burns and chemical or electrical burns need medical care right away. Some people need treatment at specialized burn centers and monthslong follow-up care.

Symptoms

Burn symptoms vary depending on how deep the skin damage is. It can take a day or two for the symptoms of a severe burn to develop.

• First-degree burn, also called superficial burn. This minor burn affects only the outer layer of the skin, which is called the epidermis. It may cause pain and redness or other changes in skin color.
• Second-degree burn, also called partial-thickness burn. This type of burn affects both the epidermis and the second layer of skin, which is called the dermis. It may cause swelling and red, white or splotchy skin. Blisters may develop, and pain can be terrible. Deep second-degree burns can cause scarring.
• Third-degree burn, also called full-thickness burn. This burn involves all of the layers of skin and sometimes the fat and muscle tissue under the skin. Burned areas may be black, brown or white. The skin may look leathery. Third-degree burns can destroy nerves, so there may be little or no pain.

When to see a doctor

Call 911 or seek immediate care for:

• Burns that may be deep, involving all layers of the skin.
• Burns that cause the skin to be dry and leathery.
• Burns that look charred or have patches of white, brown or black.
• Burns that are larger than 3 inches (about 8 centimeters) wide.
• Burns that cover the hands, feet, face, neck, groin, buttocks or a major joint, or burns that encircle an arm or a leg.
• Difficulty breathing due to breathing in smoke or fumes.
• Headache or nausea due to exposure to fire and smoke.
• Burns that begin swelling very quickly.
• Major burns that were caused by chemicals, gunpowder or an explosion.
• Electrical burns, including those caused by lightning.
• A sunburn with a fever greater than 103 degrees Fahrenheit (39 degrees Celsius) and vomiting.
• An infection over a sunburned area.
• A sunburn with confusion or passing out.
• A sunburn with dehydration.

Take first-aid measures while waiting for emergency assistance.

A minor burn might need emergency care if it affects the eyes, mouth, hands or genitals. Babies and older adults might need emergency care for minor burns as well.

Call your healthcare professional if you experience:

• Signs of infection, such as oozing and streaks from the wound, and fever.
• A burn or blister that's wider than 2 inches (about 5 centimeters) or doesn't heal in two weeks.
• New symptoms that can't be explained.
• A burn and also have a history diabetes.

Also call your health professional if you think you might need a tetanus booster. You may need a booster shot if you haven't had a tetanus shot in the past five years. Try to get this within three days of the injury.

Causes

Burns are caused by:

• Fire.
• Hot liquid or steam.
• Hot metal, glass or other objects.
• Electrical currents.
• Nonsolar radiation, such as that from X-rays.
• Sunlight or other sources of ultraviolet radiation, such as tanning beds.
• Chemicals such as strong acids, lye, paint thinner or gasoline.
• Abuse.

Risk factors

Risk factors for burns include:

• Workplace factors. People who work outdoors and people who work with flames, chemicals and other substances that cause burns are at increased risk of burns. Most burns occur in adults.
• Dementia. Older adults with dementia are more likely to have burns from heat sources, such as too-hot tap water, hot drinks, food fats and cooking oils.
• Being young. Very young children are unable to get away from heat sources or flames. Their burns often come from kitchen, car seat and bath hazards.
• Alcohol. Risk of burns is increased among people who drink alcohol or use other substances that affect judgment.

Complications

Complications of deep or widespread burns can include:

• Infection. Examples include bacterial infection, tetanus, and pneumonia.
• Fluid loss. This includes low blood volume, which is also known as hypovolemia.
• Dangerously low body temperature. This is known as hypothermia.
• Breathing problems. These can occur after taking in hot air or smoke.
• Irregular heartbeats. Also called arrythmias, irregular heartbeats can occur after electrical burns.
• Scars and changes in skin color. Scars or ridged areas can be caused by an overgrowth of scar tissue. These types of scars are called hypertrophic scars or keloids. Black people have an increased risk of this type of scarring and may benefit from seeing a burn specialist or surgeon. Other people may develop skin color changes after burns if healed skin is lighter or darker than skin that wasn't burned.
• Pain. Burn scars can be painful. Some people may experience itching or discomfort related to damaged nerves, causing numbness or tingling.
• Bone and joint problems. Scar tissue can shorten and tighten skin, muscles or tendons. This condition is also known as a contracture.
• Depression and anxiety disorders.
• Skin cancer. Skin cancer can sometimes happen in scars from previous burns. Contact your healthcare professional if you notice a sore that isn't healing within a burn scar.

Prevention

Burns are very common, and most of them are preventable. Kitchen-related injuries from hot drinks, soups and microwaved foods are especially common among children. You can take steps to reduce the risk of household burns.

Kitchen, car seat and bath hazards

• Never leave items cooking on the stove unattended.
• Turn pot handles toward the rear of the stove, or cook on the back burners.
• Don't carry or hold a child while cooking at the stove.
• Keep hot liquids out of the reach of children and pets.
• Check the temperature of food before serving it to a child. Don't heat a baby's bottle in the microwave.
• Never cook while wearing loose-fitting clothes. They could catch fire over the stove.
• If small children are present, block their access to heat sources. Examples include stoves, outdoor grills and fireplaces.
• Before placing a child in a car seat, check for hot straps or buckles.
• Set your water heater's thermostat to below 120 degrees Fahrenheit (48.9 degrees Celsius) to prevent scalding. Older adults and young children are at increased risk of burns from tap water. Always test bathwater before using it.

Electrical devices

• Unplug irons, space heaters and similar devices when not in use. Store them out of reach of small children.
• Keep electrical appliances away from water.
• Cover unused electrical outlets with safety caps.
• Keep electrical cords and wires out of the way so that children can't chew on them.

Fire prevention

• If you smoke, quit. If you don't quit, never smoke in bed.
• Blow out candles before leaving the room or sleeping.
• Be sure you have working smoke detectors on each floor of your home. Check them and change their batteries at least once a year.
• Keep a fire extinguisher handy and learn how to use it.

Chemical hazards

• When using chemicals, always wear protective eyewear and clothing.
• Keep chemicals, lighters and matches out of the reach of children. Use safety latches. And don't use lighters that look like toys.