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SKIN BURNS OVERVIEW — Skin burn injuries are common, with over one million burn injuries occurring every year in the United States. Skin burns can result from exposure to several possible sources, including hot water or steam, hot objects or flames, chemicals, electricity, or overexposure to the sun.
Most skin burns are minor and can be managed at home. However, it is important to know the signs of a more serious skin burn, which should be evaluated and treated by a health care provider. Moderate to severe burns can cause a number of serious complications and usually require urgent treatment.
This article discusses skin burns caused by steam, hot water, or other hot objects in the home, including which burns can be treated at home and those that require evaluation and treatment by a health care provider. Other topics that discuss burns are also available. (See "Emergency care of moderate and severe thermal burns in adults" and "Treatment of minor thermal burns" and "Topical chemical burns: Initial assessment and management" and "Electrical injuries and lightning strikes: Evaluation and management".)
SKIN BURN SYMPTOMS
When to seek help — If you have any of the following, you should call your health care provider:
●If the burn involves the face, hands or fingers, genitals, or feet.
●If the burn is on or near a joint (knee, shoulder, hip).
●If the burn encircles a body part (arm, leg, foot, chest, finger).
●If the burn is large (greater than the size of an orange) or deep (any second- or third-degree burn). If you have any doubt about whether the burn is large or deep, it is best to see a health care provider. (See 'Burn type' below.)
●If the victim is young (less than five years) or older than 70 years.
●If there are signs of skin infection, such as increasing redness, pain, pus-like discharge, or temperature greater than 100.4°F or 38°C.
Burn type — Burns can be classified into three severities (first, second, and third degree) based on the depth of injury to the skin.
The depth of a burn can change over the first few days. This means that a burn may appear superficial initially and then become deeper over time. If you are unsure of how deeply your skin is burned, contact a health care provider.
First-degree (superficial-thickness) burns — First-degree burns (also called superficial burns) involve only the top layer of skin. They are painful, dry, and red; and blanch when pressed (picture 1). These burns do not form a blister and generally heal in three to six days without any scarring. Non-blistering sunburns are a good example of a first-degree skin burn.
Second-degree (partial-thickness) burns — Second-degree burns (also called partial-thickness burns) involve the top two layers of skin. These burns form blisters, are very painful, may seep fluid, and blanch when pressed (picture 2). Second-degree burns typically heal within 7 to 21 days. The burned area may permanently become darker or lighter in color and may form a scar. A scald burn that forms a blister is a good example of a second-degree burn.
Third-degree (partial-thickness) burns — Third-degree burns (also called full-thickness burns) extend through all layers of the skin, completely destroying the skin. The burned area usually does not hurt. It can range in color from a deep red to waxy white to leathery gray or charred black. There may or may not be a blister. The skin does not change color when touched (picture 3). Third-degree burns cannot heal without surgical treatment such as skin grafts.
SKIN BURN TREATMENT — Small first- and second-degree burns can often be treated at home. However, burns that are larger, involve critical areas of the body, or are deeper should be evaluated by a health care provider. (See 'When to seek help' above.)
Home treatment of a skin burn should include immediately cooling it and stopping the burning process, cleaning the area, preventing infection, and managing pain.
Cool the area — The burning process should be stopped immediately. Once this is done, you can apply a cold compress to the skin or soak the area in cool (not ice) water for a brief period of time to reduce pain and reduce the extent of the burn. Avoid placing ice directly on the skin because this can damage the skin further. Avoid soaking the burn longer than 15 minutes.
Clean the area — Remove any clothing from the burned area. If clothing is stuck to the skin, do not try to remove it, and seek emergency medical care. You can wash the burned skin gently with cool tap water and plain soap. It is not necessary to disinfect the skin with alcohol, iodine, or other cleansers. In fact, these substances can be irritating and painful.
Prevent infection — To prevent infection, second- and third-degree burns can be covered with a thin layer of antibiotic ointment such as bacitracin and covered with a "non-stick" bandage. Change the dressing once or twice per day, as needed. First-degree burns require only the application of an unscented lotion/aloe vera and avoidance of the sun. Do not apply other substances (eg, mustard, egg whites, mayonnaise, butter, lavender oil, emu oil, toothpaste) to skin burns. Keep burns clean by washing the burned area daily with soap (does not need to be antibacterial) and lukewarm water.
Do not try to break open/drain skin blisters with a needle or fingernail because this can increase the risk of skin infection. The blister will open and drain on its own with time.
Tetanus prevention — If you have not had a tetanus shot in the past five years and your burn is second or third degree, you need a tetanus booster vaccine. (See "Patient education: Vaccines for adults (Beyond the Basics)".)
Treat pain — Elevating burns on the hand or foot above the level of the heart can help to prevent swelling and pain.
You may take a non-prescription pain medication, such as acetaminophen (eg, Tylenol) or ibuprofen (Advil, Motrin) if needed for pain. If your pain is not controlled with these medications, contact your health care provider. People with more severe or larger burns may require a prescription pain medication. Topical anesthetic (numbing) agents should not be used regularly on burn wounds, as irritation may occur, and the effects will wear off sooner with prolonged use.
Avoid scratching the skin — Many people are bothered by itching as the burned skin begins to heal. Try to avoid scratching the skin. Use a moisturizing lotion if needed. A non-prescription antihistamine such as diphenhydramine (eg, Benadryl) may help reduce itching.
SKIN BURN FOLLOW UP — If your burn is not healing, becomes more painful, or appears infected (redness spreading greater than 2 cm from the edge of the burn), you should see a health care provider soon.
Most skin burns that are small and first or second degree will heal within one to two weeks and will not usually scar. In some patients with second degree burns, the skin may become darker or lighter in color, and this will return to normal in 6-9 months.
PREVENTING SKIN BURNS — Skin burns can often be prevented by making some important changes in your home.
●Set the thermostat on your hot water heater no higher than 120°F (49°C). If you cannot adjust your hot water heater, install an anti-scald device on your shower, bath, or faucet.
●Keep lit candles, matches, and lighters out of the reach of children.
●Do not smoke while on supplemental oxygen.
●Do not smoke when sleepy, after taking sedatives or sleeping pills, or after drinking alcohol.
●Install a smoke detector on each floor of your home. Test the batteries in smoke detectors once per month and change batteries yearly.
●Keep hot foods and drinks, irons, and curling irons away from the edge of counters and tables.
●Use a cool-mist humidifier rather than a warm-mist or steam humidifier.
●Keep children away from hot stoves, fireplaces, and ovens. Turn pot handles inward and cook on the rear burners when possible. Never carry a child in your arms while cooking.
●Children's sleepwear should be non-flammable. Sweatpants and loose t-shirts are not as safe as sleepwear. Cotton sleepwear should fit snugly.
●Cover car seats, seat belts, and strollers with a blanket or towel if you must leave them in a parked car on a hot day. Be careful when placing the child in the seat because metal and vinyl can become very hot.
●Prevent sunburn by applying sunscreen liberally and staying out of the sun when possible. Sunburn prevention is discussed in detail separately. (See "Patient education: Sunburn prevention (Beyond the Basics)".)
WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Sunburn (The Basics)
Patient education: Skin burns (The Basics)
Patient education: Acute compartment syndrome (The Basics)
Patient education: Electrical burns (The Basics)
Patient education: Blisters (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Vaccines for adults (Beyond the Basics)
Patient education: Sunburn prevention (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Emergency care of moderate and severe thermal burns in adults
Electrical injuries and lightning strikes: Evaluation and management
Topical chemical burns: Initial assessment and management
Treatment of minor thermal burns
The following organizations also provide reliable health information.
●Kids Health
(http://kidshealth.org/parent/firstaid_safe/emergencies/burns.html)
●American Burn Association
●Medline Plus
(http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm, available in Spanish)
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