Burns and scalds

Burns can be caused by flames, ultraviolet (UV) radiation, hot liquids, electricity, lightning and certain chemicals. All burns need immediate first aid. Deeper burns require urgent medical attention, and the deepest may need surgery such as a skin graft.

Types of burns#

Burns are usually described by how deeply they damage the skin. There are three broad levels:

• Superficial burns damage only the top layer of skin. The burn site is red and painful.
• Partial thickness burns damage the first and second layers of skin. The site is red, painful, blistered and swollen, and may peel or leak clear or yellowish fluid.
• Full thickness burns damage both skin layers plus the underlying tissue, and sometimes the muscle or bone beneath. The site often looks black or charred, with white, exposed fatty tissue. Because the nerve endings are usually destroyed, there may be little or no pain at the centre of a full thickness burn, although surrounding partial thickness areas can be very painful.

It can be difficult to tell partial and full thickness burns apart. In the first few minutes, the depth of the burn is less important than its extent – how much of the body is affected. Partial and full thickness burns, and any major burn, need urgent medical attention.

First aid for burns#

• Remove the person from danger and prevent further injury.
• Hold the burn under cool running water for 20 minutes. A cool or lukewarm shower is ideal for larger areas.
• If needed, prevent heat loss by covering unburnt areas.
• Remove burnt clothing only if it is not stuck to the burn. Never pull away clothing that is stuck.
• Do not apply anything other than water to partial or full thickness burns until they are fully cooled and medically assessed.

For chemical burns, wash acids and alkalis off with running water for at least 20 minutes. Take care not to splash the chemical onto unaffected skin, yourself or others.

Superficial burns usually need pain relief, dressings and regular review to make sure they do not become infected.

Major burns are a medical emergency#

A major burn is any burn that involves more than 20 per cent of total body surface area in an adult, or more than 10 per cent in a child. Immediately apply cool water to all affected areas, then call your local emergency number for an ambulance. A cool or lukewarm shower is ideal while you wait.

Always call your local emergency number for a major burn, or any burn where breathing may have been affected.

Possible complications of major burns#

• injury to the lungs from smoke inhalation
• hypovolaemia – loss of fluid from burnt skin, which can lead to shock
• hypothermia – burnt skin cannot regulate body temperature properly, so heat is lost
• infection

Treatment in hospital#

Treatment on admission to an emergency department may include:

• pain relief (morphine may be required)
• a cool shower
• intravenous fluids through a drip
• intensive medical monitoring
• topical antiseptics and wound dressings

Staff will decide whether you need care in a specialised burns unit. Burns are generally referred to a burns unit when they meet certain criteria, which often include:

• partial or full thickness burns over 10 per cent of body surface in adults
• partial or full thickness burns over 5 per cent of body surface in children
• respiratory burns affecting the lungs or other parts of the breathing system
• circumferential burns that go right around a part of the body
• burns to the hands, feet, face, perineum or joints
• electrical burns
• chemical burns

Skin graft surgery#

If the body cannot heal the injury on its own, skin grafts may be needed. The details depend on the location and severity of the burns. Skin grafts are usually performed under anaesthetic in an operating theatre.

Self-care for burns#

Follow all self-care instructions from your doctor. General suggestions include:

• Rest as much as you can.
• Avoid moving or stretching the area, as this can injure a skin graft.
• Keep dressings dry.
• If antibiotics have been prescribed to reduce the risk of infection, take the full course.

A range of dressings may be used. Silver-impregnated dressings help protect against infection, and medical-grade honey also has antiseptic properties. Foam dressings absorb moisture and protect the wound. Non-adhesive dressings are generally preferred.

See your doctor if you notice signs of infection, such as a change in the colour of the wound, discharge, or a foul or sickly sweet odour – or if you experience any other unusual symptoms.

Key points#

• Burns can be caused by flames, UV radiation, hot liquids, electricity, lightning and certain chemicals.
• All burns need immediate first aid: cool the burn under running water for 20 minutes.
• In the first few minutes, the extent of a burn matters more than its depth.
• Do not remove clothing stuck to a burn, and do not apply anything but water to deeper burns until they are cooled and assessed.
• A major burn (more than 20 per cent of body surface in adults, more than 10 per cent in children) is a medical emergency – call your local emergency number.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).