Burns

What are burns?

Burns are a type of injury that happens when something — usually something hot — damages tissues of your body. They’re more severe when they’re deeper and cover a larger part of your body’s surface area.

Burns are extremely common and usually unintentional. Worldwide, about 10 million people experience burns, and about 180,000 die from them each year. In the U.S., about 486,000 people receive medical care for burns each year.

Types of burns

There are five types of burns:

• Thermal burns (hot or cold). These involve cell damage from extreme temperatures.
• Electrical burns. These happen when electrical energy overloads your cells. Electricity also generates heat and causes thermal damage.
• Friction burns. These burns happen when something rubs against your body hard enough to generate heat. The amount of force needed for these burns usually causes other types of damage, too.
• Radiation burns. This happens when different forms of radiation damage your cells, which then break down and die.
• Chemical burns. These happen when chemicals, usually ones that are acidic (acids) or alkaline (bases), try to react with your cells and destroy them.

Degrees of burns

Experts determine how severe a burn is partly by how deep it goes. The older system of rating burns by degrees is no longer in widespread use. Instead, experts use the following system:

• Superficial (similar to first-degree). These only damage the epidermis, the top layer of skin. These are minor and always self-treatable.
• Partial-thickness (similar to second-degree). These go deeper, damaging the outer two layers of your skin. They can blister, cause color or texture changes more than just simple redness and be painful.
• Full-thickness (similar to third-degree). These burns go through all skin layers and can reach all the way to the fatty tissue underneath the dermis. Full-thickness burns destroy nerve endings, so they don’t hurt.

Burns can extend even deeper and damage muscles, nerves, bones and other deep tissues. These aren’t as common, and experts sometimes call these fourth-degree burns.

What are the symptoms of burns?

Common symptoms of burns include:

• Pain. Burns can hurt a lot, especially when they’re in sensitive places like on your hands or face. And while full-thickness burns don’t hurt, the area around them may.
• Skin appearance or texture changes. Superficial burns can cause peeling, while partial-thickness burns can cause blistering. Deeper, more severe burns can make your skin leathery and stiff.
• Skin color changes. Superficial burns can cause red skin (or red-tinged skin if your skin is naturally darker). Partial-thickness burns can make your skin blister. Full-thickness burns can char your skin black or make it look ashen and gray. Burned skin can also have a different color while it heals.

What causes burns?

Burns can happen in many ways, including:

• Touching something too hot or cold, like a hot stove or dry ice.
• Contact with very hot air (like air from an open flame or an electric hair dryer) or very cold air (like severe wind chill that causes frostbite on exposed skin).
• Contact with very hot liquids (like boiling water) or very cold liquids (like liquid nitrogen).
• Conducting electrical current through your body from things like downed power lines, damaged power cables/cords, lightning and automobile batteries.
• Falling on paved surfaces, which can cause road rash.
• Moving against rougher fabrics — like in clothing, upholstery, carpets — with a lot of force and/or for an extended time.
• Staying in the sun too long without adequate protection.
• Receiving medical treatments like radiation therapy.
• Contact with chemicals like those found in cleaning products and construction supplies.

What complications can burns lead to?

Burns can cause many complications, ranging from minor to life-threatening. Some of the most common complications include:

• Infections. Damaged skin can’t keep germs out, which is part of why burns are prone to infections.
• Scarring. Deeper burns may not heal easily and may form scar tissue rather than regenerate normal skin.
• Swelling (edema). It’s common for people with burns to experience some swelling (different from blisters). Severe burns can cause swelling in parts of your body away from the burn, too.

More severe complications can happen when burns are deeper and cover more of your body’s surface area. Some of these serious or dangerous complications can include:

• Dehydration and shock from fluid and blood loss
• Compartment syndrome from swelling that cuts off blood circulation
• Trouble breathing from burn-related damage or complications
• Hypothermia because damaged skin affects how your body regulates its temperature
• Organ damage and failure as your kidneys and liver try to filter damaged tissue from your blood
• Digestion and metabolism issues either due to the burn or from other complications
• Sepsis, an overwhelming, life-threatening immune reaction to spreading infections
• Blood clot formation leading to deep vein thrombosis

The complications that are more likely in your case can vary depending on many factors. Your healthcare provider can tell you more about what to expect in your case.

How are burns diagnosed?

A healthcare provider can diagnose burns by examining the injury and by asking questions about what happened. If you’re unable to answer, they may rely on input from first responders or others who were there.

Lab and imaging tests don’t usually help diagnose burns but can help catch complications before they become severe. Blood and urine tests are especially important for finding signs of organ damage or infections. And CT scans and magnetic resonance imaging may help detect deeper tissue damage in some cases, but these aren’t usually necessary.

How are burns treated?

Treating burns depends on how deep they go and how much of your body’s surface area they cover. Superficial burns are always minor and you can treat them yourself. When deciding how to treat a burn or if it needs medical care, remember the following Dos and Don’ts:

Do:

• Stop or remove the source of the burn immediately (like taking off clothing soaked in hot liquid to limit the burn’s severity).
• Run cool water over the burn (except with certain causes of chemical burns).
• Keep the burned area clean and protected when possible.
• Get medical attention for partial-thickness burns that are larger than you can cover with your hand, or for any full-thickness burn.

Don’t:

• Use home remedies like bleach or butter on any burn.
• Apply ointments or creams on any burn that might be partial- or full-thickness.
• Use ice on burns (this can actually make the burn worse).
• Break burn blisters (this can increase your risk of an infection).

You can treat pain with over-the-counter medications like acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®). Talk to a healthcare provider if you have any concerns about whether you can take these.

Treatments for burns that are larger and more severe

You always need professional medical care for partial-thickness burns that are too large to cover with your hand. You also always need professional care for all full-thickness burns.

Professional care can include the following treatments:

• Treatments for pain. These range from over-the-counter or prescribed medications to treatments like nerve blocks.
• Cleaning and debriding. This removes debris and dead or dying tissue.
• Dressing/protection. Bandages temporarily protect burns from debris, germs and more.
• Surgery. This can help burns heal and reduce scarring.
• Skin grafts. Your tissues can use these like a preset framework, speeding up healing.
• Wound care. Burns may need specialized care to heal properly. This may include removing damaged tissue (debridement), hyperbaric oxygen therapy, dressing management and more.
• Therapy. Physical and occupational therapy care can help you recover from serious physical injuries from a burn.
• Mental health care. This can help with anxiety, depression or injury-related post-traumatic stress disorder (PTSD).

The treatments that might benefit you specifically can vary. Your healthcare provider can offer information tailored to your situation, preferences and needs.

Are burns preventable?

Yes, experts estimate that up to 90% of burns are preventable. Some key ways to prevent burns include:

• Teach children about fire and supervise them. Children should learn not to play with fire or electricity, and you should make sure they aren’t unattended around potential burn sources.
• Reduce the risk of scalds. Use travel mugs and keep open containers of hot liquids away from counter or tabletop edges. Set your water heater to 120 degrees Fahrenheit (49 degrees Celsius). Feel bathwater before putting children in and don’t let young children bathe unsupervised.
• Cook safely. Use proper protective items like oven mitts and don’t improvise with towels. Make sure stovetops or ovens are off when you’re done. Be sure to angle handles away from you so children can’t grab them and they can’t snag on your clothes. And keep children and pets out of the kitchen during meal prep.
• Unplug heated devices when not using them. That includes devices like curling irons, hair straighteners, clothing irons, etc.
• Use caution with electricity. Don’t overload power strips or outlets. Make sure to cover power outlets so children can’t hurt themselves. Keep electrical devices away from water sources like sinks, bathtubs or showers. And don’t use devices, cables or power cords with exposed wiring.
• Use sunscreen. Choose products with an SPF of at least 50 and reapply at least every two hours.

What can I expect if I have a burn?

What you can expect from a burn depends on how severe and large the burn is.

• Superficial burns usually heal within a few days without any scarring.
• Partial-thickness burns can take up to three weeks to heal. Scars are usually faint and fade over time, especially with shallower burns.
• Full-thickness burns take more than three weeks to heal. The extended healing time means they scar heavily without proper care. That’s why they always need medical attention.

Many other factors can affect what you should expect from a burn and during your recovery. Your healthcare provider can tell you more about what to expect and the outlook for your specific case.

When should I see my healthcare provider or seek care?

Seek medical care if:

• The burn isn’t getting better within a few days or looks worse
• Pain medications like acetaminophen or ibuprofen don’t help
• The pain is worse than you’d expect based on how the burn looks

When should I go to the hospital?

Call 911 or your local emergency services number, or seek immediate medical attention with the following:

• A partial-thickness or full-thickness burn that’s on your eyes, ears, face, hands, feet or around your genitals
• If the burn starts oozing fluid or has a foul smell to it
• If you have symptoms of an infection like a fever, swelling around the burn, dizziness or the skin around the burn is warmer to the touch

What questions should I ask my healthcare provider?

Some questions you can ask your healthcare provider include:

• How long should it take my burn to heal?
• Will my burn need additional treatments?
• What can I do to help my burn heal?
• What activities should I avoid?
• What symptoms mean I need to call your office or go to the hospital?