Burns and scalds

What are burns and scalds?

Burns and scalds are damage to the skin caused by heat. Both are treated in the same way.

A burn is caused by dry heat, from an iron or fire for example. A scald is caused by something wet, such as hot water or steam.

Burns can be very painful and can cause

and charred, black or red skin.

Read more information about the

, including the different types of burn.

Treating burns and scalds

To treat a burn, follow the

advice below:

• Immediately get the person away from the heat source to stop the burning.
• Cool the burn with cool or lukewarm water for 10-30 minutes. Do not use ice, iced water or any creams or greasy substances, such as butter.
• Remove any clothing or jewellery that is near the burnt area of skin, but do not move anything that is stuck to the skin.
• Make sure the person keeps warm – for example by using a blanket – but take care not to rub it against the burnt area.
• Cover the burn by placing a layer of cling film over it.
• Use painkillers, such as
  paracetamol
  or
  ibuprofen
  , to treat any pain.

Read more about

.

The British Red Cross website has a video about first aid for burns.

When to get medical attention

Depending on how serious a burn is, it may be possible to treat it at home. For minor burns, keep the burn clean and do not burst any blisters that form.

More serious burns will require professional medical attention. You should go to a hospital A&E department for:

• all chemical and electrical burns
• large or deep burns – any burn bigger than your hand
• full thickness burns of all sizes – these burns cause white or charred skin
• partial thickness burns on the face, hands, arms, feet, legs or genitals – these are burns that cause blisters

If someone has breathed in smoke or fumes, they should also seek medical attention. Some symptoms may be delayed and can include coughing, a sore throat, difficulty breathing or facial burns.

People who are at greater risk from the effects of burns, such as children under five years old and pregnant women, should also get medical attention after a burn or scald.

The size and depth of the burn will be assessed and the affected area cleaned before a dressing is applied. You should also be given instructions on changing your dressing.

Read more information about

.

Symptoms of a burn or scald

The symptoms of a burn or scald will vary depending on how serious it is. Some minor burns can be very painful, while some major burns may not hurt at all.

Symptoms of a burn may include:

• red skin
• peeling skin
• blisters
• swelling
• white or charred skin

The amount of pain you feel is not always related to how serious the burn is.

Your skin

Your skin is your body’s largest organ. It has many functions, including acting as a barrier between you and the environment and regulating your temperature. Your skin is made up of three layers:

• The epidermis (the outer layer of your skin) is 0.5-1.5mm thick. It has five layers of cells that work their way up to the surface of your skin, where dead cells are shed approximately every two weeks.
• The dermis (the underlying layer of fibrous tissue) is 0.3-3mm thick and is made up of a mix of three types of tissue. The dermis contains your hair follicles and sweat glands, as well as small blood vessels and nerves.
• The subcutaneous fat or subcutis (the final layer of fat and tissue) varies in thickness from person to person. It contains your larger blood vessels and nerves, and regulates the temperature of your skin and body.

Types of burn

Burns are assessed by how seriously your skin is damaged. There are four main types of burn:

• superficial epidermal burns
• superficial dermal burns
• deep dermal or partial thickness burns
• full thickness burns

These are described in more detail below.

Superficial epidermal burns

Superficial epidermal burns are where the epidermis is damaged. Your skin will be red, slightly swollen and painful but not blistered.

Superficial dermal burns

Superficial dermal burns are where the epidermis and part of the dermis are damaged. Your skin will be pale pink, painful and there may be small blisters.

Deep dermal or partial thickness burns

Deep dermal or partial thickness burns are where the epidermis and the dermis are damaged. This type of burn makes your skin turn red and blotchy. Your skin may also be dry or moist, become swollen and blistered, and it may be very painful or painless.

Full thickness burns

Full thickness burns are where all three layers of skin (the epidermis, dermis and subcutis) are damaged. In this type of burn, the skin is often burnt away and the tissue underneath may appear pale or blackened. The remaining skin will be dry and white, brown or black with no blisters. The texture of the skin may also be leathery or waxy.

Treatment for burns or scalds

Appropriate first aid must be used to treat any burns or scalds as soon as possible. This will limit the amount of damage to your skin.

You may need to apply the following first aid techniques to yourself or to another person who has been burnt.

First aid for burns

Follow the

advice below to treat burns and scalds:

• Stop the burning process as soon as possible. This may mean removing the person from the area, dousing flames with water or smothering flames with a blanket. Do not put yourself at risk of getting burnt as well.
• Remove any clothing or jewellery near the burnt area of skin. However, don't try to remove anything that is stuck to the burnt skin because this could cause more damage.
• Cool the burn with cool or lukewarm water for 10–30 minutes, ideally within 20 minutes of the injury occurring. Never use ice, iced water or any creams or greasy substances, such as butter.
• Keep yourself or the person warm. Use a blanket or layers of clothing, but avoid putting them on the injured area. Keeping warm will prevent
  hypothermia
  , when a person’s body temperature drops below 35C (95F). This is a risk if you are cooling a large burnt area, particularly in young children and elderly people.
• Cover the burn with cling film. Put the cling film in a layer over the burn, rather than wrapping it around a limb. A clean, clear plastic bag can be used for burns on your hand.
• Treat the pain from a burn with
  paracetamol
  or
  ibuprofen
  . Always check the manufacturer’s instructions when using over-the-counter (OTC) medication. Children under 16 years of age should not be given
  aspirin
  .

When to go to hospital

Once you have taken these steps, you will need to decide whether further medical treatment is necessary. Go to a hospital for:

• all chemical and electrical burns (see below)
• large or deep burns – any burn bigger than the affected person’s hand
• full thickness burns of all sizes – these burns cause white or charred skin
• partial thickness burns on the face, hands, arms, feet, legs or genitals – these are burns that cause
  blisters

Also get medical help straight away if the person with the burn:

• has other injuries that need treating or is going into shock (signs include cold, clammy skin, sweating, rapid, shallow breathing and weakness or dizziness)
• is pregnant
• is over 60 years of age
• is under five years of age
• has a medical condition such as heart, lung or liver disease, or diabetes (a long-term condition caused by too much glucose in the blood)
• has a weakened immune system (the body’s defence system), for example because of
  HIV or AIDS
  or because they're having
  chemotherapy
  for cancer

If someone has breathed in smoke or fumes, they should also seek medical attention. Some symptoms may be delayed and can include coughing, a sore throat, difficulty breathing, singed nasal hair or facial burns.

Read more about

for information on how serious burns are treated.

Electrical burns

Electrical burns may not look serious, but they can be very damaging. Someone who has an electrical burn should seek immediate medical attention at an A&E department.

If the person has been injured by a low-voltage source (up to 220–240 volts) such as a domestic electricity supply, safely switch off the power supply or remove the person from the electrical source using a non-conductive material. This is a material that does not conduct electricity, such as a wooden stick or a wooden chair.

Do not approach a person who is connected to a high-voltage source (1,000 volts or more).

Chemical burns

Chemical burns can be very damaging and require immediate medical attention at an A&E department.

If possible, find out what chemical caused the burn and tell the healthcare professionals at A&E.

If you are helping someone else, wear appropriate protective clothing, then:

• remove any clothing that has the chemical on it from the person who has been burnt
• if the chemical is dry, brush it off their skin
• use running water to remove any traces of the chemical from the burnt area

Sunburn

In cases of

, follow the advice below:

• If you notice any signs of sunburn, such as hot, red and painful skin, move into the shade or preferably inside.
• Take a cool bath or shower to cool down the burnt area of skin.
• Apply after-sun lotion to the affected area to moisturise, cool and soothe it. Do not use greasy or oily products.
• If you have any pain, paracetamol or ibuprofen should help relieve it. Always read the manufacturer’s instructions and do not give aspirin to children under 16 years of age.
• Stay hydrated by drinking plenty of water.
• Watch out for signs of heat exhaustion or heatstroke, when the temperature inside your body rises to 37–40°C (98.6–104°F) or above. Symptoms include dizziness, a rapid pulse or vomiting.

If a person with heat exhaustion is taken quickly to a cool place, given water to drink and has their clothing loosened, they should start to feel better within half an hour. If they don’t, they could develop heatstroke. This is a medical emergency and you’ll need to call for an ambulance.

Read more about what to do if someone has heat exhaustion or heatstroke.

Read more information about the

.

Recovery from a burn or scald

How long it takes to recover from a burn or scald depends on how serious it is and how it is treated. If the wound becomes infected, seek further medical attention.

Burns that don't need medical attention

If your burn or scald is mild and treated at home, it should heal without the need for further treatment. Read more about

.

Keep the burn clean and do not apply any creams or greasy substances. Do not burst any blisters because this can lead to infection.

Burns that need medical attention

If you have a burn or scald that requires medical treatment, it will be assessed to determine the level of care required. If the burn is severe, you may be referred to a specialist.

The healthcare professional treating you will:

• assess the size and depth of the burn by examining the area
• clean the burn, being careful not to burst any blisters
• cover the burn with a sterile dressing, usually a pad and a gauze bandage to hold it in place
• offer you pain relief if necessary (usually
  paracetamol
  or
  ibuprofen
  )

Depending on how the burn happened, you may be advised to have an injection to prevent

(a condition caused by bacteria entering a wound). For example, a tetanus injection may be recommended if there is a chance that soil has got into the wound.

Your dressing will be checked after 24 hours to make sure there are no signs of infection. It will be changed after 48 hours, and then every three to five days until it is completely healed.

Seek further medical attention if:

• the wound becomes painful or smelly
• you develop a high temperature of 38C (100.4F) or higher
• the dressing becomes soaked with fluid leaking from the wound
• the wound has not healed after two weeks

Minor burns will normally heal in around 14 days, leaving minimal scarring.

Exposure to the sun

During the first two years after your burn, you should not expose the damaged skin to direct sunlight as this may cause it to blister. It is especially sensitive during the first year after the injury. This also applies to a new area of skin after a skin graft.

It is important to keep the area covered with cotton clothing. If the burn or scald is on your face, wear a peaked cap or wide-brimmed hat when you're out in the sun. Total sun block, for example one with a sun protection factor (SPF) of 50, should be used on all affected areas.

The area can be exposed to sunshine again around three years after the injury, but it is still very important to apply a high-factor suncream (SPF 25 or above) and stay out of the midday sun.

Complications from burns and scalds

Complications from burns and scalds can include:

• going into shock
• heat exhaustion and heatstroke
• infection
• scarring

Shock

After a serious injury, it is possible to go into shock. Shock is a life-threatening condition that occurs when there is an insufficient supply of oxygen to the body. It's possible to go into shock after a serious burn.

Signs and symptoms of shock include:

• a pale face
• cold or clammy skin
• a rapid pulse
• fast, shallow breathing
• yawning
• unconsciousness

Dial 999 and ask for an ambulance if you think that someone who has been seriously injured is going into shock.

While you wait for the ambulance:

• lay the person down (if their injuries allow it) and raise and support their legs
• use a coat or blanket to keep them warm, but do not cover their face or the burnt area
• do not give them anything to eat or drink

Heat exhaustion and heatstroke

are two heat-related health conditions that happen when the temperature inside your body rises to 37-40C (98.6-104F) or above.

Both heat exhaustion and heatstroke can be very serious. They are often caused by being exposed to too much sunlight or heat. Similarly, if someone is sunburnt, they may be at risk of developing heat exhaustion or heatstroke.

Symptoms of heat exhaustion and heatstroke include:

• extreme tiredness and lack of energy
• dizziness or fainting
• feeling sick or vomiting
• rapid pulse
• headache
• muscle pain
• irritability
• confusion

If a person with heat exhaustion is taken quickly to a cool place, given water to drink and has their clothing loosened, they should start to feel better within half an hour. If they don’t, they could develop heatstroke. This is a medical emergency and you’ll need to call 999 for an ambulance.

Read more about what to do if someone has heat exhaustion or heatstroke.

Infection

Wounds can become infected if bacteria get into them. If your burn or scald has a blister that has burst, it may become infected if it is not kept clean. Seek medical attention for any burn that causes a blister.

Your wound may be infected if:

• it is uncomfortable, painful or smelly
• you have a high temperature of 38C (100.4F) or higher
• you have signs of
  cellulitis
  , a bacterial infection that causes redness and swelling of the skin

Seek immediate medical attention if you think your burn has become infected. An infection can usually be treated with antibiotics and painkilling medication, if necessary.

In rare cases, an infected burn can cause blood poisoning (

) or (TSS). These are serious conditions that can be fatal if not treated. Signs of sepsis and toxic shock syndrome include a high temperature, dizziness and vomiting.

Scarring

A

is a patch or line of tissue that remains after a wound has healed. Most minor burns only leave minimal scarring. You can try to reduce the risk of scarring after the wound has healed by:

• applying an
  emollient
  , such as aqueous cream or emulsifying ointment, two or three times a day
• using sunscreen with a high sun protection factor (SPF) to protect the area from the sun when you are outside