Burns

Burns are tissue damage brought on by heat, chemicals, electricity, radiation or the sun. First-degree burns, and most second-degree burns, heal with at-home treatments. Third-degree burns can be life-threatening and require specialized medical care.

What is a burn?

A burn occurs when heat, chemicals, sunlight, electricity or radiation damages skin tissue. Most burns happen accidentally. There are different degrees of burns. Your healthcare provider determines the seriousness (degree) of a burn based on the depth of the burn and the amount of affected skin. Burns can be painful. Left untreated, a burn can lead to infection.

How common are burns?

Close to half a million people go to the emergency department every year with burn injuries. Children are at high risk for accidental burns. Every day, more than 300 children receive emergency treatment for burn injuries.

Who might get a burn?

Accidental burns can happen to anyone, although children, teenagers and older people are most at risk. These age groups are more prone to burn injuries from cooking, such as spilling a boiling pan of water onto skin. Children and teens are also more likely to mess around with lighters, matches and fireworks or get sunburns.

What are the types of burns?

Healthcare providers classify burns by degrees of severity. Your provider will evaluate the extent of skin damage. Burn degrees include:

• First-degree burns are mild (like most sunburns). The top layer of skin (epidermis) turns red and is painful but doesn’t typically blister.

• Second-degree burns affect skin’s top and lower layers (dermis). You may experience pain, redness, swelling and blistering.

• Third-degree burns affect all three skin layers: epidermis, dermis and fat. The burn also destroys hair follicles and sweat glands. Because third-degree burns damage nerve endings, you probably won’t feel pain in the area of the burn itself, rather adjacent to it. Burned skin may be black, white or red with a leathery appearance.

SYMPTOMS AND CAUSES

What causes burns?

Many things can cause a burn. Thermal sources, including fire, hot liquids, steam and contact with hot surfaces, are the most common causes of burns. Other causes include exposure to:

• Chemicals, such as cement, acids or drain cleaners.

• Radiation

• Electricity

• Sun (ultraviolet or UV light).

What are the signs of burns?

Burn symptoms vary depending on the severity or degree of the burn. Symptoms are often worse during the first few hours or days after the burn. Burn symptoms include:

• Blisters.

• Pain.

• Swelling.

• White or charred (black) skin.

• Peeling skin.

DIAGNOSIS AND TESTS

How are burns diagnosed?

Your healthcare provider will examine the burn to determine the degree or severity. This process involves estimating the percentage of the body affected by the burn and its depth. Your provider may classify the burn as:

• Minor :First- and second-degree burns that cover less than 10% of the body are considered minor and rarely require hospitalization.

• Moderate :Second-degree burns that cover about 10% of the body are classified as moderate. Burns on the hands, feet, face or genitals can range from moderate to severe.

• Severe :Third-degree burns that cover more than 1% of the body are considered severe.

MANAGEMENT AND TREATMENT

How are burns managed or treated?

Burn treatment varies depending on the cause and severity. You need to keep all burns clean and apply proper bandages/dressing depending on the severity of the wounds. Treating the person’s pain is key: inadequate control can interfere with wound care.

Continue to check wounds for signs of infection and other long term issues, such as scarring and tightening of the skin over joints and muscles, which makes them difficult to move.

Treatments by burn type include:

• First-degree burns : Run cool water over the burn. Don’t apply ice. For sunburns, apply aloe vera gel. For thermal burns, apply antibiotic cream and cover lightly with gauze. You can also take over-the-counter pain medication.

• Second-degree burns : Treatment for second- and first-degree burns is similar. Your healthcare provider may prescribe a stronger antibiotic cream that contains silver, such as silver sulfadiazine, to kill bacteria. Elevating the burned area can reduce pain and swelling.

• Third-degree burns : Third-degree burns can be life-threatening and often require skin grafts. Skin grafts replace damaged tissue with healthy skin from another of the uninjured part of the person’s body. The area where the skin graft is taken from generally heals on its own. If the person does not have enough skin available for a graft at the time of injury, a temporary source of graft can come from a deceased donor or a human-made (artificial) source but these will eventually need to be replace by the person’s own skin. Treatment also includes extra fluids (usually given intravenously, with an IV) to keep blood pressure steady and prevent shock and dehydration.

What are the complications of burns?

Third-degree burns that are deep and affect a large portion of skin are very serious and can be life-threatening. Even first- and second-degree burns can become infected and cause discoloration and scarring. First-degree burns don’t cause scarring.

Potential complications of third-degree burns include:

• Arrhythmia, or heart rhythm disturbances, caused by an electrical burn.

• Dehydration.

• Disfiguring scars and contractures.

• Edema (excess fluid and swelling in tissues).

• Organ failure.

• Pneumonia.

• Seriously low blood pressure (hypotension) that may lead to shock.

• Severe infection that may lead to amputation or sepsis.

PREVENTION

How can I prevent a burn?

Burns have many accidental causes. You can take these steps to reduce the risk of burns:

• Wear sunscreen.

• Set your home’s hot water heater below 120 degrees Fahrenheit.

• Always test the water in a shower or bath before getting in or bathing a child.

• Lock up chemicals, lighters and matches.

• Use the stove’s back burners as much as possible when cooking, turn handles of pots and pans where they won’t be bumped and don’t leave the stove unattended.

• Don’t hold a child when you’re near hot objects, such as the stove.

• Set safeguards around a fireplace and never leave a child unattended.

• Install and regularly test smoke detectors in your home.

• Stock your home with fire extinguishers and know how to use them.

• Cover electrical outlets.

OUTLOOK / PROGNOSIS

What is the prognosis (outlook) for people with burns?

With proper treatment, most first- and second-degree burns heal over two to three weeks. Depending on the burn severity, you may have some scarring, which may fade over time. People recovering from third-degree burns need physical and occupational therapy to maintain joint mobility and improve function. Some people develop post-traumatic stress disorder (PTSD) or depression after a burn event. Thanks to medical advancements, many people who have burns covering even up to 90% of their bodies survive .

When should I call the doctor?

• Burns on the hands, feet, face or genitalia.

• Burns that don’t improve after two weeks.

• Blistering.

• Severe pain.

• Fever, yellow or green discharge, or other signs of infection.

• Signs of PTSD or depression.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• What degree is the burn?

• What is the best treatment for this burn?

• What steps can I take to lower the risk of infection?

• What steps can I take to lower the risk of scarring?

• What steps can I take to lower the future risk of accidental burns?

• Should I look out for signs of complications?