A burn is damage to the skin and sometimes to the underlying tissues. Burns are categorized according to the depth and extent of the damage to the skin:
Superficial burn (also called first-degree burn)
Mildest type of burnOften caused by ultraviolet light, or very short (“flash") flame exposureAffects only the outer layer of the skin (epidermis)Normally does not cause scarringTakes about 3-6 days to heal
Superficial partial-thickness burn (also called second-degree burn)
Often caused by a scald (spill or splash) or short (“flash”) flame exposureAffects the outer layer of the skin more deeply, usually causing blisteringMay or may not cause scarring, but often does cause long-term skin color changesTakes about 1-3 weeks to heal
Deep partial-thickness burn (also called second-degree burn)
Often caused by a scald (spill), may involve flame, oil, or greaseAffects the outer and underlying layer of skin (dermis), causing blisteringUsually causes scarringUsually takes more than three weeks to heal
Full-thickness burn (also called third-degree burn)
Very seriousOften caused by scald (immersion), may involve flame, steam, oil, grease, chemicals, or high-voltage electricityDamages all layers of the skin, and may involve the tissues underneath (muscle and bone)Causes scarringWill heal only at the wound edges by scarring, unless skin grafting is done
Classification of Skin Burns
Copyright © Nucleus Medical Media, Inc.
Burns can be caused by:
Heat or flame (thermal burns)
Hot foods or drinks such as boiling water, tea, or coffeeHot oil or greaseHot tap waterDirect heat such as stoves, heaters, or curling ironsDirect flameFlammable liquids such as gasolineFireworks
Chemicals (chemical burn)—strong acids or strong bases such as:
Cleaning productsBattery fluidPool chemicalsDrain cleaners
or tanning beds
Damaged electrical cordsElectrical outletsHigh-voltage wiresLightning
Radiation (radiation burn)
Nuclear radiationX-raysRadiation therapy
for cancer treatment
Burns are more common in males, and in those aged under 4 years. Other factors that may increase the chance of burns include: SmokingAlcohol useIllegal drug useLow socioeconomic statusAbsent or non-functioning smoke detectorsSubstandard or older housingUnsupervised or improperly supervised childrenUsing tap water hotter than 120° F
Burn symptoms and signs vary depending on the type of burn.
Burned area turns red and is painfulThe area blanches (turns white) when you press on itThe area may swell, but it is dry and there is no blistering
BlistersThe area is moist, red, and weepingThe area blanches (turns white) when you press on itPainful to air and temperature
Blisters, usually loose and easily unroofedThe area can be wet or waxy dryThe skin color can vary from patchy, to cheesy white, to redThe area does not blanch (turn white) with pressureMay or may not be painful, can perceive pressure
Skin can appear waxy white, leathery gray, or charred and blackenedMay not be painful if nerves have been damaged, the only sensation may be deep pressure
The doctor will ask how the burn occurred and will examine the burned area.
Treatment will depend on the cause of the burn, how deep the burn is, and how much of the body the burn covers. Doctors have methods and charts to estimate the total percentage of body surface area (TBSA) affected by the injury. This estimate is age dependent. For example, the head represents a larger percentage of surface area in a baby than in an adult.
Quick treatment is important and can lessen the damage to the tissues. First aid for minor burns may involve: Cooling the burn with running water or a cold damp cloth. Do not use ice—this may result in more damage to the skin.Do not use butter, grease, oils, or ointments on the burn.Cover the burn with sterile gauze or a clean cloth.Do not use a fluffy cloth such as a towel or blanket.Take an over-the-counter pain reliever, like acetaminophen (Tylenol).Do not break or pop any blisters.
This may result in an infection.
If you see signs of an infection, get medical attention. Signs of infection include:
Increased painRednessFeverSwellingOozing of pus
Once a minor burn is completely cooled, you can consider using a fragrance-free lotion or moisturizer to prevent drying and make the area more comfortable.
For more serious burns, like deep partial-thickness or full-thickness burns, seek medical attention or call emergency medical services. Until an emergency unit arrives: Do not take off any clothing that is stuck to the burn.Make sure the victim is not near, or in contact with, any smoldering materials or exposed to further smoke or heat.Do not soak the burn in water, but you can cover the area with a cool, moist sterile bandage or clean cloth.
As with any severe injury, make sure the person is breathing and administer
A doctor will decide if hospitalization is necessary based on many factors. These include age, the cause of the burn, and the extent and depth of the burn. Reasons to hospitalize a person who has more than a minor burn may include: Age: younger than five years or older than 55 yearsSuspected child abuseVery small, deep burns on the hands, face, eyes, feet, or perineum (groin/genital area)Extensive burn: using TBSA and age chartsBurns that may require complicated dressing changes, elevation, or continued physician observationHigh-voltage injury or burnSuspected or known inhalation injuryCircumferential burn
Other medical problems that predispose a person to infection, such as:
DiabetesImmunosuppressionSickle cell disease
If the burn is serious, the following treatments may be administered in a hospital: Oxygen
to help with breathing
IntubationIV fluids to replace those lost from the burnSkin graftSplints—placed on joints to help maintain mobilityPhysical therapy, in the case of large burns
Most burns are the result of accidents. To help reduce the chance of burns:
about fire prevention and keep dangerous materials out of reach.
Make sure smoke detectors are installed and in working order. Replace batteries twice a year. One way to remember to do this is to change the batteries the same days you change the clocks for daylight savings and standard times.When cooking, keep pot handles turned toward the back of the stove.Supervise young children in the kitchen and around fireworks.Set the temperature on the water heater to less than 120° F and test the bath water before your child gets in.Make sure children’s sleepwear is flame-resistant.Don’t hold children in your arms or lap while cooking, serving, or eating hot foods or liquids.Do not leave matches, lighters, candles, or burning cigarettes unattended.Wear protective gloves and clothing when handling caustic chemicals.Put protective covers on electrical outlets.Do not wear loose-fitting sleeves while cooking.Keep children and pets away from the stove while cooking.Make sure electrical cords are not hanging over the edge of countertops.Store chemicals and cleaners in a locked cabinet.Children younger than one year can sustain partial-thickness burns from hot seat belt straps or buckles in car seats. Make sure car seats are not hot before putting a child in the seat. If you park in the sun, cover the seat with a towel.
Behrman R, Kliegman R, et al.
Nelson Textbook of Pediatrics.
18th ed. Philadelphia, PA: Saunders; 2007.
The Merck Manual of Medical Information. 2nd ed. London, England: Simon and Schuster, Inc; 2003.
First aid for burns. American Academy of Pediatrics Healthy Children website.
http://www.healthychildren.org/English/safety-prevention/all-around/Pages/First-Aid-For-Burns.aspx. Updated September 2, 2014. Accessed November 3, 2014.
Goldman L, Ausiello D, eds
Cecil Textbook of Internal Medicine.
23rd ed. Philadelphia, PA: Saunders; 2008.
Major burns. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 24, 2014. Accessed November 3, 2014.
Marx J, Hockberger R, et al.
Rosen's Emergency Medicine.
7th ed. St. Louis, MO: Mosby; 2009.
Minor burns. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2014. Accessed November 3, 2014.
Protect the ones you love: burns. Centers for Disease Control
and Prevention website. Available at:
http://www.cdc.gov/SafeChild/Fact_Sheets/Burns-Fact-Sheet-a.pdf. Accessed November 3, 2014.
Topical treatment and dressing of burns. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2014. Accessed November 3, 2014.
Last reviewed December 2014 by Marcin Chwistek, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.