Burns are one of the most common household injuries, especially among children. The term “burn” means more than the burning sensation associated with this injury. Burns are characterized by severe skin damage that causes the affected skin cells to die.
Most people can recover from burns without serious health consequences, depending on the cause and degree of injury. More serious burns require immediate emergency medical care to prevent complications and death.
There are three primary types of burns: first-, second-, and third-degree. Each degree is based on the severity of damage to the skin, with first-degree being the most minor and third-degree being the most severe. Damage includes:
- first-degree burns: red, nonblistered skin
- second-degree burns: blisters and some thickening of the skin
- third-degree burns: widespread thickness with a white, leathery appearance
There are also fourth-degree burns. This type of burn includes all of the symptoms of a third-degree burn and also extends beyond the skin into tendons and bones.
Burns have a variety of causes, including:
- scalding from hot, boiling liquids
- chemical burns
- electrical burns
- fires, including flames from matches, candles, and lighters
- excessive sun exposure
The type of burn is not based on the cause of it. Scalding, for example, can cause all three burns, depending on how hot the liquid is and how long it stays in contact with the skin.
Chemical and electrical burns warrant immediate medical attention because they can affect the inside of the body, even if skin damage is minor.
First-degree burns cause minimal skin damage. They are also called “superficial burns” because they affect the outermost layer of skin. Signs of a first-degree burn include:
- minor inflammation, or swelling
- dry, peeling skin occurs as the burn heals
Since this burn affects the top layer of skin, the signs and symptoms disappear once the skin cells shed. First-degree burns usually heal within 7 to 10 days without scarring.
You should still see your doctor if the burn affects a large area of skin, more than three inches, and if it’s on your face or a major joint, which include:
First-degree burns are usually treated with home care. Healing time may be quicker the sooner you treat the burn. Treatments for a first-degree burn include:
- soaking the wound in cool water for five minutes or longer
- taking acetaminophen or ibuprofen for pain relief
- applying lidocaine (an anesthetic) with aloe vera gel or cream to soothe the skin
- using an antibiotic ointment and loose gauze to protect the affected area
Make sure you don’t use ice, as this may make the damage worse. Never apply cotton balls to a burn because the small fibers can stick to the injury and increase the risk of infection. Also, avoid home remedies like butter and eggs as these are not proven to be effective.
Second-degree burns are more serious because the damage extends beyond the top layer of skin. This type burn causes the skin to blister and become extremely red and sore.
Some blisters pop open, giving the burn a wet or weeping appearance. Over time, thick, soft, scab-like tissue called fibrinous exudate may develop over the wound.
Due to the delicate nature of these wounds, keeping the area clean and bandaging it properly is required to prevent infection. This also helps the burn heal quicker.
Some second-degree burns take longer than three weeks to heal, but most heal within two to three weeks without scarring, but often with pigment changes to the skin.
The worse the blisters are, the longer the burn will take to heal. In some severe cases, skin grafting is required to fix the damage. Skin grafting takes healthy skin from another area of the body and moves it to the site of the burned skin.
As with first-degree burns, avoid cotton balls and questionable home remedies. Treatments for a mild second-degree burn generally include:
- running the skin under cool water for 15 minutes or longer
- taking over-the-counter pain medication (acetaminophen or ibuprofen)
- applying antibiotic cream to blisters
However, seek emergency medical treatment if the burn affects a widespread area, such as any of the following:
Excluding fourth-degree burns, third-degree burns are the most severe. They cause the most damage, extending through every layer of skin.
There is a misconception that third-degree burns are the most painful. However, with this type of burn the damage is so extensive that there may not be any pain because of nerve damage.
Depending on the cause, the symptoms third-degree burns can exhibit include:
- waxy and white color
- dark brown color
- raised and leathery texture
- blisters that do not develop
Without surgery, these wounds heal with severe scarring and contracture. There is no set timeline for complete spontaneous healing for third-degree burns.
Never attempt to self-treat a third-degree burn. Call 911 immediately. While you’re waiting for medical treatment, raise the injury above your heart. Don’t get undressed, but make sure no clothing is stuck to the burn.
Compared with first- and second-degree burns, third-degree burns carry the most risk for complications, such as infections, blood loss, and shock, which is often what could lead to death. At the same time, all burns carry the risk of infections because bacteria can enter broken skin.
Tetanus is another possible complication with burns of all levels. Like sepsis, tetanus is a bacterial infection. It affects the nervous system, eventually leading to problems with muscle contractions. As a rule of thumb, every member of your household should receive updated tetanus shots every 10 years to prevent this type of infection.
Severe burns also carry the risk of hypothermia and hypovolemia. Dangerously low body temperatures characterize hypothermia. While this may seem like an unexpected complication of a burn, the condition is actually prompted by excessive loss of body heat from an injury. Hypovolemia, or low blood volume, occurs when your body loses too much blood from a burn.
The obvious best way to fight burns is to prevent them from happening. Certain jobs put you at a greater risk for burns, but the fact is that most burns happen at home. Infants and young children are the most vulnerable to burns. Preventive measures you can take at home include:
- Keep children out of the kitchen while cooking.
- Turn pot handles toward the back of the stove.
- Place a fire extinguisher in or near the kitchen.
- Test smoke detectors once a month.
- Replace smoke detectors every 10 years.
- Keep water heater temperature under 120 degrees Fahrenheit.
- Measure bath water temperature before use.
- Lock up matches and lighters.
- Install electrical outlet covers.
- Check and discard electrical cords with exposed wires.
- Keep chemicals out of reach, and wear gloves during chemical use.
- Wear sunscreen every day, and avoid peak sunlight.
- Ensure all smoking products are stubbed out completely.
- Clean out dryer lint traps regularly.
It’s also important to have a fire escape plan and to practice it with your family once a month. In the event of a fire, make sure to crawl underneath smoke. This will minimize the risk of passing out and becoming trapped in a fire.
When properly and quickly treated, the outlook for first- and second-degree burns is good. These burns rarely scar but can result in a change in pigment of the skin that was burned. The key is to minimize further damage and infection. Extensive damage from severe second-degree and third-degree burns can lead to problems in deep skin tissues, bones, and organs. Patients may require:
- physical therapy
- lifelong assisted care
It’s important to gain adequate physical treatment for burns, but don’t forget to find help for your emotional needs. There are support groups available for people who have experienced severe burns, as well as certified counselors. Go online or talk to your doctor to find support groups in your area. You can also use other resources such as Burn Survivor Assistance and the Children’s Burn Foundation.
You asked, we answered
- Why is icing a burn harmful?
Icing a burn wound can ease the initial pain that is associated with the injury. But ultimately, icing a burn wound will slow the healing process. Moreover, in some instances, icing a burn wound can cause frostbite to an already damaged and sensitive skin area. It’s better to run the burn wound under running cool water and cover the area with clean gauze without ointment.- Modern Weng, D.O.