The damage to the human body caused by burns and scalds can range in severity from a mildly annoying injury to severe life-threatening harm
Burns happen when the skin is exposed to dry heat. They can be caused by contact with a hot ktichen utensil or from the heat of a fire.
Scalds are caused by hot fluids or gases, for example boiling water, steam or hot fat.Introduction
The damage to the body caused by burns and scalds are usually classified by one of three categories:
- First-degree burns damage only the outer layer of skin
- Second-degree burns damage the outer layer and the layer underneath
- Third-degree burns damage or destroy the deepest layer of skin and tissues underneath
First-degree burns can be treated at home and usually heal in seven to ten days. Second-degree and third-degree burns are much more serious and require medical attention as there is a risk of infection and shock (dangerously low drop in blood pressure) developing.
Symptoms of burns and scalds
The symptoms of a burn or scald will vary depending on how serious it is. Some minor burns can be very painful, while some major burns may not hurt at all.
Symptoms of a burn may include:
- red skin
- peeling skin
- white or charred skin
The amount of pain you feel is not always related to how serious the burn is.
Your skin is your body's largest organ. It has many functions, including acting as a barrier between you and the environment and regulating your temperature. Your skin is made up of three layers:
- the epidermis (the outer layer of your skin) is 0.5-1.5mm thick – it has five layers of cells that work their way up to the surface of your skin, where dead cells are shed approximately every two weeks
- the dermis (the underlying layer of fibrous tissue) is 0.3-3mm thick and is made up of a mix of three types of tissue – it contains your hair follicles and sweat glands, as well as small blood vessels and nerves
- the subcutaneous fat, or subcutis (the final layer of fat and tissue) varies in thickness from person to person – it contains your larger blood vessels and nerves, and regulates the temperature of your skin and body
Types of burn
Burns are assessed by how seriously your skin is damaged. There are four main types of burn, which tend to have a different appearance and different symptoms:
- superficial epidermal burns
- superficial dermal burns
- deep dermal or partial thickness burns
- full thickness burns
However, in many cases different areas of a single burn will have features of more than one of these types.
Superficial epidermal burns
Superficial epidermal burns are where the epidermis is damaged. Your skin will be red, slightly swollen and painful, but not blistered.
Superficial dermal burns
Superficial dermal burns are where the epidermis and part of the dermis are damaged. Your skin will be pale pink and painful, and there may be small blisters.
Deep dermal or partial thickness burns
Deep dermal or partial thickness burns are where the epidermis and the dermis are damaged. This type of burn makes your skin turn red and blotchy. Your skin may also be dry or moist, become swollen and blistered, and it may be very painful or painless.
Full thickness burns
Full thickness burns are where all three layers of skin (the epidermis, dermis and subcutis) are damaged. In this type of burn, the skin is often burnt away and the tissue underneath may appear pale or blackened. The remaining skin will be dry and white, brown or black with no blisters. The texture of the skin may also be leathery or waxy.
Treating burns and scalds
Appropriate first aid must be used to treat any burns or scalds as soon as possible. This will limit the amount of damage to your skin.
You may need to apply the following first aid techniques to yourself or to another person who has been burnt.
First aid for burns
Follow the first aid advice below to treat burns and scalds:
- Stop the burning process as soon as possible. This may mean removing the person from the area, dousing flames with water or smothering flames with a blanket. Do not put yourself at risk of getting burnt as well.
- Remove any clothing or jewellery near the burnt area of skin. However, don't try to remove anything that is stuck to the burnt skin because this could cause more damage.
- Cool the burn with cool or lukewarm water for 10 to 30 minutes, ideally within 20 minutes of the injury occurring. Never use ice, iced water or any creams or greasy substances such as butter.
- Keep yourself or the person warm. Use a blanket or layers of clothing, but avoid putting them on the injured area. Keeping warm will prevent hypothermia, where a person's body temperature drops below 35ºC (95ºF). This is a risk if you are cooling a large burnt area, particularly in young children and elderly people.
- Cover the burn with cling film. Put the cling film in a layer over the burn, rather than wrapping it around a limb. A clean clear plastic bag can be used for burns on your hand.
- Treat the pain from a burn with paracetamol or ibuprofen. Always check the manufacturer's instructions when using over-the-counter (OTC) medication. Children under 16 years of age should not be given aspirin.
When to go to hospital
Once you have taken these steps, you will need to decide whether further medical treatment is necessary. Go to a hospital accident and emergency (A&E) department for:
- large or deep burns – any burn bigger than the affected person's hand
- full thickness burns of all sizes – these burns cause white or charred skin
- partial thickness burns on the face, hands, arms, feet, legs or genitals – these are burns that cause blisters
- all chemical and electrical burns
Also get medical help straight away if the person with the burn:
- has other injuries that need treating
- is going into shock – signs include cold clammy skin, sweating, rapid shallow breathing and weakness or dizziness
- is pregnant
- is over 60 years of age
- is under five years of age
- has a medical condition such as heart, lung or liver disease, or diabetes
- has a weakened immune system (the body's defence system), for example because of HIV or AIDS, or because they're having chemotherapy for cancer
If someone has breathed in smoke or fumes, they should also seek medical attention. Some symptoms may be delayed and can include coughing, a sore throat, difficulty breathing, singed nasal hair or facial burns.
Electrical burns may not look serious, but they can be very damaging. Someone who has an electrical burn should seek immediate medical attention at an A&E department.
If the person has been injured by a low-voltage source (up to 220-240 volts) such as a domestic electricity supply, safely switch off the power supply or remove the person from the electrical source using a non-conductive material. This is a material that does not conduct electricity, such as a wooden stick or a wooden chair.
Do not approach a person who is connected to a high-voltage source (1,000 volts or more).
Chemical burns can be very damaging and require immediate medical attention at an A&E department.
If possible, find out what chemical caused the burn and tell the healthcare professionals at A&E.
If you are helping someone else, wear appropriate protective clothing, then:
- remove any clothing on the person that has the chemical on it
- if the chemical is dry, brush it off their skin
- use running water to remove any traces of the chemical from the burnt area
In cases of sunburn, follow the advice below:
- If you notice any signs of sunburn, such as hot, red and painful skin, move into the shade or preferably inside.
- Take a cool bath or shower to cool down the burnt area of skin.
- Apply after-sun lotion to the affected area to moisturise, cool and soothe it. Do not use greasy or oily products.
- If you have any pain, paracetamol or ibuprofen should help relieve it. Always read the manufacturer's instructions and do not give aspirin to children under 16 years of age.
- Stay hydrated by drinking plenty of water.
- Watch out for signs of heat exhaustion or heatstroke, where the temperature inside your body rises to 37-40°C (98.6-104°F) or above. Symptoms include dizziness, a rapid pulse or vomiting.
If a person with heat exhaustion is taken to a cool place quickly, given water to drink and has their clothing loosened, they should start to feel better within half an hour. If they don't, they could develop heatstroke. This is a medical emergency and you'll need to call 999 for an ambulance.
Recovering from burns and scalds
How long it takes to recover from a burn or scald depends on how serious it is and how it is treated. If the wound becomes infected, seek further medical attention.
Burns that don't need medical attention
If your burn or scald is mild and treated at home, it will normally heal without the need for further treatment. Read more about first aid for burns and scalds.
While the skin heals, keep the area clean and do not apply any creams or greasy substances. Do not burst any blisters because this can lead to infection.
If you have scalded the inside of your mouth by drinking something hot, try to avoid things that can irritate the scalded area, such as hot and spicy food, alcohol and smoking, until the area heals.
Mild burns or scalds that only affect the uppermost layer of skin (superficial epidermal burns) will usually heal in about a week without any scarring.
Burns that need medical attention
If you have a burn or scald that requires medical treatment, it will be assessed to determine the level of care required.
The healthcare professional treating you will:
- assess the size and depth of the burn by examining the area
- clean the burn, being careful not to burst any blisters
- cover the burn with a sterile dressing, usually a pad and a gauze bandage to hold it in place
- offer you pain relief if necessary (usually paracetamol or ibuprofen)
Depending on how the burn happened, you may be advised to have an injection to prevent tetanus (a condition caused by bacteria entering a wound). For example, a tetanus injection may be recommended if there is a chance that soil has got into the wound.
Your dressing will be checked after 24 hours to make sure there are no signs of infection. It will be changed after 48 hours, and then every three to five days until it is completely healed.
Minor burns affecting the outer layer of skin and some of the underlying layer of tissue (superficial dermal burns) will normally heal in around 14 days, leaving minimal scarring.
If the burn is severe, you may be referred to a specialist. In some cases, it may be necessary to have surgery to remove the burnt area of skin and replace it with a skin graft taken from another part of your body.
More severe and deeper burns can take months or even years to fully heal, and will usually leave some visible scarring.
Expert opinion is divided over the management of blisters that are caused by burns. However, it is recommended that you should not burst any blisters yourself.
If your burn has caused a blister, you should seek medical attention. The blister will probably remain intact, although some burns units at hospitals follow a policy of deroofing blisters. Deroofing means removing the top layer of skin from the blister.
In some cases, a needle may be used to make a small hole in the blister to drain the fluid out. This is known as aspiration and may be carried out on large blisters or blisters that are likely to burst.
Your healthcare professional will advise you about the best way to care for your blister and what type of dressing you should use.
Exposure to the sun
During the first few years after a burn, you should try to avoid exposing the damaged skin to direct sunlight as this may cause it to blister. It is especially sensitive during the first year after the injury. This also applies to a new area of skin after a skin graft.
It is important to keep the area covered with cotton clothing. If the burn or scald is on your face, wear a peaked cap or wide-brimmed hat when you're out in the sun. Total sun block – for example, one with a sun protection factor (SPF) of 50 – should be used on all affected areas.
The area can be exposed to sunshine again around three years after the injury, but it is still very important to apply a high-factor sun cream (SPF 25 or above) and stay out of the midday sun.
Complications of burns and scalds
Burns and scalds can sometimes lead to further problems, including shock, heat exhaustion, infection and scarring.
After a serious injury, it is possible to go into shock. Shock is a life-threatening condition that occurs when there is an insufficient supply of oxygen to the body. It's possible to go into shock after a serious burn.
Signs and symptoms of shock include:
- a pale face
- cold or clammy skin
- a rapid pulse
- fast, shallow breathing
Dial 999 and ask for an ambulance if you think that someone who has been seriously injured is going into shock.
While you wait for the ambulance:
- lay the person down (if their injuries allow it) and raise and support their legs
- use a coat or blanket to keep them warm, but do not cover their face or the burnt area
- do not give them anything to eat or drink
Heat exhaustion and heatstroke
Heat exhaustion and heatstroke are two heat-related health conditions that happen when the temperature inside your body rises to 37-40°C (98.6-104°F) or above.
Both heat exhaustion and heatstroke can be very serious. They are often caused by being exposed to too much sunlight or heat.
Symptoms of heat exhaustion and heatstroke include:
- extreme tiredness and lack of energy
- dizziness or fainting
- feeling sick or vomiting
- rapid pulse
- muscle pain
If a person with heat exhaustion is taken quickly to a cool place, given water to drink and has their clothing loosened, they should start to feel better within half an hour. If they don't, they could develop heatstroke. This is a medical emergency and you'll need to call 999 for an ambulance.
Wounds can become infected if bacteria get into them. If your burn or scald has a blister that has burst, it may become infected if it is not kept clean. Seek medical attention for any burn that causes a blister.
Your wound may be infected if:
- it is uncomfortable, painful or smelly
- you have a high temperature of 38°C (100.4°F) or higher
- you have signs of cellulitis, a bacterial infection that causes redness and swelling of the skin
Seek immediate medical attention if you think your burn has become infected. An infection can usually be treated with antibiotics and painkilling medication, if necessary.
In rare cases, an infected burn can cause blood poisoning (sepsis) or toxic shock syndrome (TSS). These are serious conditions that can be fatal if not treated. Signs of sepsis and toxic shock syndrome include a high temperature, dizziness and vomiting.
A scar is a patch or line of tissue that remains after a wound has healed. Most minor burns only leave minimal scarring. You can try to reduce the risk of scarring after the wound has healed by:
- applying an emollient, such as aqueous cream or emulsifying ointment, two or three times a day
- using sunscreen with a high sun protection factor (SPF) to protect the healing area from the sun when you are outside
Preventing burns and scalds
Many severe burns and scalds affect babies and young children. The following advice can help reduce the chances of your child having a serious accident.
In the kitchen
- it's best to keep your toddler out of the kitchen, well away from kettles, saucepans and hot oven doors – you could put a safety gate across the doorway to stop them getting in
- use a kettle with a short or curly cord to stop it hanging over the edge of the work surface, where it could be grabbed
- when cooking, use the rings at the back of the cooker and turn saucepan handles towards the back so your child can't grab them
In the bathroom
- never leave a child under five alone in the bath, even for a moment
- fit a thermostatic mixing valve to your bath's hot tap to control the temperature
- put cold water into the bath first, then add the hot water – use your elbow to test the temperature of the water before you put your baby or toddler in the bath
Throughout the home
- put your iron, hair straighteners or curling tongs out of reach while they cool down after you have finished using them
- fit fireguards to all fires and heaters
- keep matches, lighters and lit candles out of young children's sight and reach
- keep hot drinks well away from young children – a hot drink can still scald 20 minutes after it was made
- put hot drinks down before you hold your baby
- after warming a bottle of milk, shake the bottle well and test the temperature of the milk by placing a few drops on the inside of your wrist before feeding – it should feel lukewarm, not hot
- don't let your child drink a hot drink through a straw
- encourage your child to play in the shade (under trees, for example) especially between 11am and 3pm, when the sun is at its strongest
- keep babies under the age of six months out of direct sunlight, especially around midday
- cover your child up in loose, baggy cotton clothes, such as an oversized T-shirt with sleeves
- get your child to wear a floppy hat with a wide brim that shades their face and neck
- cover exposed parts of your child's skin with sunscreen, even on cloudy or overcast days – use a sunscreen that has a sun protection factor (SPF) of 15 or above and is effective against UVA and UVB
- reapply sunscreen often throughout the day