Burns and scalds

What are burns and scalds?

A burn is damage to your skin caused by heat, electricity, chemicals or radiation such as strong sunlight, while a scald is a burn caused specifically by something hot and wet, such as boiling water or steam. Both are treated in the same way, and how serious a burn is depends on how deep it goes and how much of your body it covers.

Symptoms of burns and scalds

The pain and appearance of a burn depend on how deep it is, and a very serious burn can sometimes hurt less than a mild one, because the nerves in the skin have been damaged. Symptoms can include:

• red, peeling or blotchy skin
• swelling
• blisters
• white, leathery, or charred and blackened skin in more serious burns.

If you've breathed in smoke or fumes, you might also develop a cough, a sore throat, difficulty breathing, or singed nasal hair. These can indicate a problem with your airway, and require urgent treatment in hospital.

Causes and risk factors

Burns happen when heat, electricity, radiation or chemicals damage your skin. They're commonly grouped by cause:

• dry burns, from flames or contact with a hot object
• scalds, from hot liquids or steam
• electrical burns, from low or high-voltage currents
• chemical burns, from household or industrial chemicals
• radiation burns, including sunburn.

Most burns happen at home or at work. Around 80–90% happen in the home, often in the kitchen from hot liquids, cooking equipment or appliances. Your risk is higher if you have young children, since burns are a leading cause of injury in the under-fives, if you're pregnant or over 60, or if you have a condition such as epilepsy or nerve damage that makes it harder to move away from a heat source quickly. Drinking alcohol and smoking also raises your risk.

Types and depths of burns

Doctors classify burns by how many layers of skin they damage. Your skin has three layers: the epidermis (the outer layer), the dermis underneath it, which contains blood vessels, nerve endings and hair follicles, and the subcutaneous fat below that.

• Superficial epidermal burns, similar to a first-degree burn, damage only the epidermis, making skin red, slightly swollen and painful, without blisters.
• Superficial dermal burns, a milder second-degree burn, damage the epidermis and part of the dermis, causing pale pink, painful skin with small blisters.
• Deep dermal, or partial thickness, burns, a more severe second-degree burn, damage the epidermis and dermis more extensively, causing red or blotchy, swollen and blistered skin that can be very painful or, confusingly, painless.
• Full thickness burns, a third-degree burn, damage all three layers of skin; the area may look pale, blackened, leathery or waxy, and often isn't painful because the nerve endings have been destroyed.

You may see burns described using either system. UK health services tend to use the depth-based names above, while 'first-degree', 'second-degree' and 'third-degree' are used more often in the US. Very rarely, burns described as fourth, fifth or sixth degree extend beyond the skin into fat, tendons, muscle or bone.

How burns are assessed

A healthcare professional will assess a burn by looking at how deep it is and how much of your body surface it covers, since both affect how serious it is and what treatment you need. They'll also check for signs of shock, such as a rapid pulse, pale or clammy skin and fast, shallow breathing, particularly with larger burns.

If you've been in a fire, you'll also be checked for smoke inhalation, since this can cause breathing problems that aren't always obvious straight away.

Treating burns and scalds

1. Stop the burning process. Move away from the heat source, and put out flames with water or by smothering them with a blanket.
2. Remove clothing or jewellery near the burn, unless it's stuck to your skin, before the area starts to swell.
3. Cool the burn under cool or lukewarm running water for 20 minutes, as soon as possible. Never use ice, iced water, creams or greasy substances such as butter.
4. Keep yourself or the person warm with a blanket, avoiding the burnt area, to prevent hypothermia.
5. Cover the burn loosely with cling film, laid over rather than wrapped around it, or use a clean plastic bag for a hand.
6. Take paracetamol or ibuprofen for pain, and seek medical advice.

Small, mild burns often heal well at home with no further treatment: keep the area clean, don't apply creams or oily substances, and don't burst any blisters, which can lead to infection.

More serious burns need hospital treatment, which may include cleaning and dressing the wound, pain relief, antibiotics if there's a risk of infection, and fluids given through a vein if you've lost a lot of body fluid. A tetanus injection may also be recommended.

For deep or extensive burns, you may need surgery to remove the burnt skin and replace it with a skin graft, healthy skin taken from another area of your body. Dressings are usually checked at 24 hours, then changed at 48 hours and every 3–5 days after that until the burn has healed.

When to get medical help

Call 999 or go to A&E straight away for:

• any burn that's very large or deep, bigger than the affected person's hand
• burns on the face, hands, arms, feet, legs or genitals that cause blisters
• burns of any size that cause white or charred skin
• all chemical or electrical burns.

Also seek urgent medical help if the person has other injuries, shows signs of shock, is pregnant, is under 5 or over 60, or has a condition such as heart, lung or liver disease, diabetes, or a weakened immune system, for example due to HIV or chemotherapy. If someone has breathed in smoke, watch for coughing, a sore throat or breathing difficulty, even if this doesn't appear straight away.

For anything less serious, call 111 or ask a pharmacist if you're not sure what to do, especially for a burn on a child under 5.