Health Library BurnsFrom Healthwise

Most burns are minor injuries that occur at home or work. It is common to get a minor burn from hot water, a curling iron, or touching a hot stove. Home treatment is usually all that is needed for healing and to prevent other problems, such as infection.

There are many types of burns.

• Heat burns (thermal burns) are caused by fire, steam, hot objects, or hot liquids. Scald burns with hot liquid are the most common burns to children and older adults.
• Electrical burns are caused by contact with electrical sources or by lightning.
• Chemical burns are caused by contact with household or industrial chemicals in a liquid, solid, or gas form. Natural foods such as chili peppers, which contain a substance irritating to the skin, can cause a burning sensation.
• Radiation burns are caused by the sun, tanning booths, sunlamps, X-rays, or radiation therapy for cancer treatment.
• Friction burns are caused by contact with any hard surface such as roads ("road rash"), carpets, or gym floor surfaces. They are usually both a scrape (abrasion) and a heat burn. Friction burns to the skin are seen in athletes who fall on floors, courts, or tracks. Motorcycle or bicycle riders who have road accidents while not wearing protective clothing might get friction burns. For information on treatment for friction burns, see the topic Scrapes.

Breathing in hot air or gases can cause injury your lungs (inhalation injuries). Breathing in toxic gases, such as carbon monoxide, can cause poisoning.

Burns injure the skin layers and can also injure other parts of the body, such as muscles, nerves, lungs, and eyes. Burns are defined as first-, second-, third-, or fourth-degree, depending on how many layers of skin and tissue are burned. The deeper the burn and the larger the burned area, the more serious the burn is.

• First-degree burns are burns of the first layer of skin. See an illustration of a first-degree burn.
• There are two types of second-degree burns:
  • Superficial partial-thickness burns injure the first and second layers of skin. See an illustration of this type of second-degree burn.
  • Deep partial-thickness burns injure deeper skin layers. See an illustration of this type of deep second-degree burn.
• Third-degree burns (full-thickness burns) injure all the skin layers and tissue under the skin. See an illustration of a third-degree burn.
• Fourth-degree burns extend through the skin to injure muscle, ligaments, tendons, nerves, blood vessels, and bones. These burns always require medical treatment.

The seriousness of a burn is determined by several factors, including:

• The depth, size, cause, affected body area, age, and health of the burn victim.
• Any other injuries that occurred, and the need for follow-up care.

Burns affect people of all ages, though some are at higher risk than others.

• About 20% of burns occur in children younger than age 5, and most of these are scald burns from hot liquids.
• About 60% of burns occur in the 18- to 64-year-old age group.
• About 10% of burns occur in older adults, mostly scald burns from hot liquids.
• Men are twice as likely to have burn injuries as women.

Burns in children

Babies and young children may have a more severe reaction from a burn than an adult. A burn in an adult may cause a minor loss of fluids from the body, but in a baby or young child, the same size and depth of a burn may cause a severe fluid loss.

A child's age determines how safe his or her environment needs to be, as well as how much the child needs to be supervised. At each stage of a child's life, look for burn hazards and use appropriate safety measures. Since most burns happen in the home, simple safety measures might prevent accidents and decrease the chance of anyone getting burned. See the Prevention section of this topic.

Most burns are accidental. When a child or vulnerable adult is burned, it is important to find out how the burn happened. If the reported cause of the burn does not match how the burn looks, abuse must be considered. Self-inflicted burns will require treatment as well as an evaluation of the person's emotional health.

Infection is a concern with all burns. Watch for signs of infection during the healing process. Home treatment for a minor burn will reduce the risk of infection. Deep burns with open blisters are more likely to become infected and need medical treatment.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

• Breathing stops. After calling 911 or other emergency services, see the topic Dealing With Emergencies.
• Signs of decreased level of consciousness develop, such as sleepiness (lethargy), confusion, extreme restlessness, or agitation.
• Moderate to severe difficulty breathing from an airway burn or chemical fumes (smoke inhalation) develops:
  • In children.
  • In adults and older children.
• Signs of shock develop:
  • In children.
  • In adults and older children.
• Other serious injuries are present.
• Burns extend through the skin to injure muscle and bones (fourth-degree burn).
• Third-degree burns are present over more than 2% of the body.
• Second-degree burns are present over:
  • More than 10% of the body of a person younger than age 10 or older than age 50.
  • More than 15% of the body of a person between ages 10 to 50.

Note:

If a chemical has been swallowed that may be a poison or may cause burning in the throat and esophagus, call your local Poison Control Center or the National Poison Control Hotline (1-800-222-1222) immediately for information on treatment. When you call the Poison Control Center, have the chemical container with you, so you can read the content label to the Poison Control staff member. The Poison Control Center can help determine what steps to take next.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Chemical has been swallowed that may be a poison or causes burning in the mouth, throat, or the esophagus: call your local Poison Control Center or the National Poison Control Hotline (1-800-222-1222) immediately for information on treatment. When you call the Poison Control Center, have the chemical container with you, so you can read the contents label to the Poison Control person. The Poison Control Center can help determine what steps to take next. You may find additional information in the Poisoning topic.
• Chemical burn to the eyes: Go to the topic Burns to the Eye.
• A friction burn: Go to the topic Scrapes.

	Yes	Do you have breathing problems or throat problems after breathing in smoke ( smoke inhalation)?
When to See a Doctor See significance of breathing problems or throat problems if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have mild difficulty breathing? Yes Do you have noisy breathing or wheezing? Yes Do you have a hoarse voice, difficulty speaking, or are you not able to speak in full sentences? Yes Do you have a lot of coughing? Yes Do you have dark-colored mucus from the nose or mouth? Call your health professional today if you answer "Yes" to the following question. Yes Do you have normal breathing while at rest, but any amount of activity causes shortness of breath? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had an electrical shock or been struck by lightning?
When to See a Doctor See significance of an electrical shock or burn if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Did lightning or electrical power cause a burn to the skin? Note: If you are not able to reach your health professional immediately, go directly to the nearest hospital emergency department. Call your health professional today if you answer "Yes" to any of the following questions. Yes Has an electrical shock caused numbness and tingling but no injury to the skin? Yes Were you struck by lightning but you do not have any injuries? Yes Were you shot by a stun gun or Taser but you do not have any injuries? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a chemical burn?
When to See a Doctor See significance of a chemical burn if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Note: If you are unable to reach your health professional immediately, call the local Poison Control Center or your National Poison Control Hotline (1-800-222-1222). When you call the Poison Control Center, have the chemical container with you, so you can read the content label to the Poison Control staff member. The Poison Control Center can help determine what steps to take next. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have a chemical burn? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have a burn?
When to See a Doctor See significance of child's burn if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Note: The following questions will help you decide if and when your child needs to see a doctor based on the size of the burn. Be sure to answer all the questions to determine if your child needs to see a doctor because of other problems caused by a burn. It can be hard to estimate the size of a burn. If you think a burn is a certain degree and size but you are unsure, it is best to discuss the degree and size of the burn with your health professional. The "rule of palm" is one way to estimate the size of a burn. The palm of the person who is burned (not fingers or wrist area) is about 1% of the body. Use the person's palm to measure the body surface area burned. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Does your child have a third-degree burn? Yes Does your child have a second-degree on his or her face, eyelids, ears, hands, feet, groin area, or over a joint? Yes Does your child have a second-degree burn covering from 1% to 10% of his or her body? Call your health professional today if you answer "Yes" to the following question. Yes Does your child have a second-degree burn that is larger than a quarter? Note: Call your health professional today to determine if a visit is needed. Your health professional may not need to see you for your burn, but he or she will want to ask you questions to determine the seriousness of the burn and what steps you need to take next. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Is the healing scar from a burn pulling the skin tight or preventing normal movement of the area? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a second- or third- degree burn?
When to See a Doctor See significance of a second- or third-degree burn if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: It can be hard to estimate the size of a burn. If you think a burn is a certain degree and size but you are unsure, it is best to discuss the degree and size of the burn with your doctor. The "rule of palm" is one way to estimate the size of a burn. The palm of the person who is burned (not fingers or wrist area) is about 1% of the body. Use the person's palm to measure the body surface area burned. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a third-degree burn on less than 2% of your body? Yes Do you have a second-degree burn on your face, eyelids, or ears? Yes Are you older than age 50 and you have a second-degree burn covering from 1% to 10% of your body? Yes Are you younger than age 50 and you have a second-degree burn covering 2% to 15% of your body? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a second-degree burn on your hands, feet, groin area, or over a joint? Yes Are you older than age 50 and you have a second-degree burn covering less than 1% of your body? Yes Are you younger than age 50 and you have a second-degree burn covering less than 2% of your body? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Is the healing scar from a burn pulling the skin tight or preventing normal movement of the area? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a burn that goes completely around (encircles) your arm or leg?
When to See a Doctor See significance of a burn that encircles a limb if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have a burn that goes completely around (encircles) your arm or leg? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think a burn may have been caused by abuse?
When to See a Doctor See significance of a burn caused by abuse if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you think a burn may have been caused by abuse? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have continuing pain from a burn?
When to See a Doctor See significance of pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: See evaluating pain in children age 3 and younger if you are having difficulty determining your child's level of pain. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have severe pain after using home treatment? Yes Do you have moderate pain that is getting worse after using home treatment? Call your health professional today if you answer "Yes" to the following question. Yes Does pain prevent you from cleaning or treating the burn properly? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had mild to moderate pain from a burn for longer than 24 hours after home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Is the healing scar from a burn pulling the skin tight or preventing normal movement of the area? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think you have an infection?
When to See a Doctor See significance of an infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease or take a medicine that causes problems with your immune system? Yes Do you have red streaks extending from the burn? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased pain, swelling, redness, or warmth around the burn? Yes Do you have pus in or around the burn? Yes Do you know or think you have a fever? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around a burn for 24 hours or longer? Yes Have you had swollen glands (lymph nodes) near a burn for 24 hours or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you know or think you need a tetanus shot?
When to See a Doctor See significance of getting a tetanus shot if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need a tetanus shot, call your doctor to arrange for the shot as soon as possible. Your need for a tetanus shot depends on the seriousness of your wound and your tetanus shot history. Your doctor may be able to tell you over the telephone if you need a tetanus shot. Call your health professional today if you answer "Yes" to any of the following questions. Yes Are you worried that the burn has gotten dirty or has germs on it and your last tetanus shot was longer than 5 years ago? Note: Something is dirty if it has dirt, soil, spit, or feces on it. Yes Are you not sure when you had your last tetanus shot? Yes Did you not get the first series of tetanus shots? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following injuries that occurred with the burn?

• Head injury: Go to the topic Head Injury, Age 4 and Older or Head Injury, Age 3 and Younger.
• Cuts: Go to the topic Cuts.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Most minor burns will heal on their own, and home treatment is usually all that is needed to relieve your symptoms and promote healing. However, if you suspect you may have a more severe injury, use first-aid measures while you arrange for an evaluation by your health professional.

Immediate first aid for burns

• First, stop the burning to prevent a more severe burn.
  • Heat burns (thermal burns): Smother any flames by covering them with a blanket or water. If your clothing catches fire, do not run: stop, drop, and roll on the ground to smother the flames.
  • Liquid scald burns (thermal burns): Run cool tap water over the burn for 10 to 20 minutes. Do not use ice.
  • Electrical burns: After the person has been separated from the electrical source, check for breathing and a heartbeat. If the person is not breathing or does not have a heartbeat, begin rescue breathing and CPR. (See Dealing With Emergencies).
  • Chemical burns: Natural foods such as chili peppers, which contain a substance irritating to the skin, can cause a burning sensation. When a chemical burn occurs, find out what chemical caused the burn. Call your local Poison Control Center or the National Poison Control Hotline (1-800-222-1222) for more information about how to treat the burn.
  • Tar or hot plastic burns: Immediately run cold water over the hot tar or hot plastic to cool the tar or plastic.
• Next, look for other injuries. If you or the person who is burned was involved in an accident that caused the burn, other serious injuries may have occurred.
• Remove any jewelry or clothing at the site of the burn. If clothing is stuck to the burn, do not remove it. Carefully cut around the stuck fabric to remove loose fabric. Remove all jewelry because it may be difficult to remove it later if swelling occurs.

Prepare for an evaluation by a health professional

If you are going to see your health professional soon:

• Cover the burn with a clean, dry cloth to reduce the risk of infection.
• Do not put any salve or medication on the burned area, so your health professional can properly assess your burn.
• Do not put ice or butter on the burned area, because these measures do not help and can damage the skin tissue.

Home treatment for minor burns

• For home treatment of first-degree burns and sunburns:
  • Use cool cloths on burned areas.
  • Take frequent cool showers or baths.
  • Apply soothing lotions that contain aloe vera to burned areas to relieve pain and swelling. Applying 0.5% hydrocortisone cream to the burned area also may help. Note: Do not use the cream on children younger than age 2 unless your doctor tells you to. Do not use in the rectal or vaginal area of children younger than age 12 unless your doctor tells you to.
• There isn't much you can do to stop skin from peeling after a sunburn—it is part of the healing process. Lotion may help relieve the itching.
• Other home treatment measures, such as chamomile, may help relieve your sunburn symptoms.

For home treatment of second-degree burns, see home treatment for second-degree burns.

First-degree burns and minor second-degree burns can be painful. Try the following to help relieve your pain:

Lotions

Some health professionals suggest using skin lotions, such as Vaseline Intensive Care or Lubriderm, on first-degree burns or second-degree burns that have unbroken healing skin. These skin lotions can be used to relieve itching but should not be used if the burns have fluid weeping from them or have fresh scabs. An antihistamine, such as Benadryl or Chlor-Trimeton, can also help stop the itching. Read and follow any warning on the label.

When a first-degree burn or minor second-degree burn is 2 to 3 days old, using the juice from an aloe leaf can help the burn heal and feel better. Applying the aloe juice may sting at first contact.

It is important to protect a burn while it is healing.

• Newly healed burns can be sensitive to temperature. Healing burns need to be protected from the cold, because the burned area is more likely to develop frostbite.
• A newly burned area can sunburn easily. Sunscreen with a high sun protective factor (SPF at least 30) should be used for the first year after a burn to protect the new skin.

Do not smoke. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Tobacco Use.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment.

• Pain, limited movement, or numbness develops.
• Difficulty breathing develops.
• Signs of infection develop.
• Symptoms become more severe or frequent.

Most burns happen in the home. Simple safety measures might prevent accidents in your home and decrease the chances of anyone getting burned.

Home safety measures

• Do not smoke in bed.
• Place smoke alarms and other fire safety devices in strategic locations in your home, such as in the kitchen and bedrooms and near fireplaces or stoves. Smoke detectors need to be checked and to have the batteries replaced regularly. A good way to remember to do this is to check smoke detectors twice a year when daylight savings and standard time change.
• Make a fire escape plan, and make sure the family knows it (babysitters, too).
• Keep a fire extinguisher near the kitchen and have it checked yearly. Learn how to use it. Put out food or grease fires in a pan with a lid or another pot.
• Set your water heater at 120 °F (50 °C) or lower. Always test the temperature of bath water.
• Store cleaning solutions and paints in containers in well-ventilated areas.
• Use proper fuses in electrical boxes, do not overload outlets, and use insulated and grounded electrical cords.
• Keep trash cleaned up in attics, basements, and garages.
• Be careful with gas equipment such as lawn mowers, snow blowers, and chain saws.
• Avoid fireworks. Think of safety first when dealing with fireworks.

Your local fire department is a good resource for more information on how to prevent fires, make a fire escape plan, use fire safety devices, and provide first-aid treatment for burns.

Child safety

Teach children safety rules for matches, fires, electrical outlets, electrical cords, stoves, and chemicals. Keep in mind child safety considerations. Prevention tips for children include the following:

• Keep matches and flames, such as candles or lanterns, out of the reach of children. Keep small children away from stoves and ovens when you are cooking, and do not place pot handles where a child can reach them. Do not let children play with any small appliances such as curling irons, hair dryers, toasters, or heating pads.
• Never hold a child while smoking or drinking a hot liquid, because any sudden movement by the child could cause an accident that causes a burn.
• Never leave hot foods or liquids within reach of children, such as on the edges of tables or counters. Also, be cautious about leaving hot liquids on a table with a tablecloth that young children can reach and pull down.
• Keep electrical cords away from a child's reach. A child chewing on a cord could cause an electrical burn of the mouth. Cover electrical outlets so children will not stick items in the outlet.
• Do not allow children to remove hot items from the oven or microwave. Use caution whenever heating baby bottles in the microwave so that the liquid does not get too hot. A liner may burst or a lid may not be secure, and when the bottle is tipped for feeding, the hot contents may burn the baby. For this reason, most health professionals recommend that bottles not be heated in the microwave.
• Teach children who are old enough to understand to stop, drop, and roll if their clothing catches on fire so they can help put out the flame and prevent getting burned more.
• Buy children's sleepwear made of flame-retardant fabric. Dress children in flame- and fire-retardant clothing. Older adults need to be careful about wearing clothing with loose material that could catch on fire.
• Keep wood stoves and fireplaces in good working condition, and use screens to keep children a safe distance away. Keep portable heaters, furnaces, water heaters, and small appliances in good working condition.
• Store cleaning solutions and chemicals out of the reach of children.

Reduce the risk of a lightning strike

In general, avoid placing camping tents under tall trees, near bodies of water, or on the highest hill in an area. Seek shelter in a covered area, such as a car, if you get caught outdoors in bad weather. If no shelter is available, lie on the ground in a ditch or take cover in a thick grove of trees, where lightning striking a single tree is unlikely.

• Avoid handling metal or electrical objects.
• Avoid or stop using any machines outdoors.
• Get out of water and off of boats.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• What caused the burn?
• What kind of material was burning (such as wood, plastic, chemical, or asbestos)?
• When did the burn occur?
• What is the size and location of the burn? Can you estimate the depth as a first-, second-, or third-degree burn?
• Was there a possibility of smoke inhalation? Was the fire in an enclosed place?
• How was the fire put out?
• Were there other injuries?
• What home treatment has been used?
• Do you have any health risks?

• Burns to the Eye
• Carbon Monoxide Poisoning
• Cuts
• Dealing With Emergencies
• Head Injury, Age 3 and Younger
• Head Injury, Age 4 and Older
• Scrapes
• Seizures
• Shock
• Sunburn

Author:	Susan Van Houten, RN, BSN, MBA	Last Updated: February 2, 2007
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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