Patient education: Skin burns (Beyond the Basics)
- Arek Wiktor, MD, FACS
Arek Wiktor, MD, FACS
- Assistant Professor of Surgery
- Burn, Trauma, Critical Care
- University of Colorado School of Medicine
- David Richards, MD, FACEP
David Richards, MD, FACEP
- Associate Professor of Emergency Medicine
- University of Colorado School of Medicine
- Section Editor
- Ron M Walls, MD, FRCPC, FAAEM
Ron M Walls, MD, FRCPC, FAAEM
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Adult Resuscitation
- Neskey Family Professor of Emergency Medicine
- Harvard Medical School
- Brigham and Women's Hospital
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
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 healthcare 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 healthcare 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" and "Environmental and weapon-related electrical injuries".)
SKIN BURN SYMPTOMS
When to seek help — If you have any of the following, you should call your healthcare 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 3 inches or 7.5 cm) or deep (any partial-thickness or full thickness). If you have any doubt about whether the burn is large or deep, it is best to see a healthcare 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 100.4ºF or 38ºC
Burn type — Burns were previously classified as first, second, third, or fourth degree, based on the thickness of the skin burned. This system is being replaced with a system that better describes which burns require surgical treatment.
The classification 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 how deeply your skin is burned, contact a healthcare provider.
Superficial skin burns — Superficial skin burns, previously called first-degree burns, involve only the top layer of skin, are painful, dry, and red, and turn white when pressed (picture 1). Superficial burns generally heal in three to six days without scarring. Non-blistering sunburns are a good example of a superficial skin burn.
Superficial partial-thickness skin burns — Superficial partial-thickness skin burns, previously called second-degree burns, involve the top two layers of skin, are painful with air movement or air temperature changes, are red and seep fluid, usually form blisters, and turn white when pressed (picture 2). Superficial partial thickness skin burns heal within seven to 21 days. The burned area may permanently become darker or lighter in color but a scar does not usually form.
Sunburns that blister after several hours are good examples of superficial partial-thickness burns.
Deep partial-thickness skin burns — Deep partial-thickness skin burns, previously called third-degree burns, extend deeper into the skin, are painful with deep pressure, almost always form blisters, and do not turn white with pressure. Deep partial-thickness skin burns take more than 21 days to heal and usually develop a scar, which may be severe.
Burns that blister immediately are deep partial-thickness burns. A blister that persists for several weeks is also considered a deep partial-thickness burn.
Full-thickness burns — Full-thickness skin burns, previously called fourth-degree burns, extend through all layers of the skin, completely destroying the skin. The burned area usually does not hurt, is a waxy white to leathery gray or charred black color, and the skin is dry and does not blanch when touched (picture 3). Full-thickness burns cannot heal without surgical treatment and scarring is usually severe.
SKIN BURN TREATMENT
Small superficial or superficial partial-thickness burns can often be treated at home. However, burns that are larger or deeper should be evaluated by a healthcare provider.
Home treatment of skin burns should include cleaning the area, immediately cooling it, preventing infection, and managing pain.
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.
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.
Cool the area — After cleaning the skin, you may 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.
Prevent infection — To prevent infection in partial-thickness and more severe burns, apply aloe vera or an antibiotic cream, such as bacitracin. Do not apply ointments or other substances (eg, mustard, egg whites, mayonnaise, 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 water.
Minor burns may be covered with a bandage or dressing if you wish; burns that form blisters should be covered with a clean bandage or dressing. A bandage that does not stick to the skin (labeled as "non-stick") is preferred for the first layer. Change the dressing once or twice per day, as needed.
Do not try to break open 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.
Tetanus prevention — If you have not had a tetanus shot in the past five years and your burn is superficial partial-thickness or deeper, you need a tetanus booster vaccine. (See "Patient education: Adult vaccines (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 healthcare 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 healthcare provider soon.
Most skin burns that are small and superficial will heal within one week and will not usually scar. After a superficial partial-thickness burn, the skin may become darker or lighter in color, but will not usually scar.
PREVENTING SKIN BURNS
Skin burns can often be prevented by making some changes in your home.
●Keep lit candles, matches, and lighters out of the reach of children.
●Do not smoke when sleepy, after taking sedatives or sleeping pills, or after drinking alcohol.
●Do not smoke while on supplemental oxygen.
●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.
●Install a smoke detector on each floor of your home. Test the batteries in smoke detectors once per month and change if needed.
●Children's sleepwear should be non-flammable. Sweat pants and loose t-shirts are not as safe as sleepwear. Cotton sleepwear should fit snugly.
●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.
●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 healthcare 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 healthcare 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.
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
Environmental and weapon-related electrical injuries
Topical chemical burns
Treatment of minor thermal burns
The following organizations also provide reliable health information.
●American Burn Association
(http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm, available in Spanish)
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.