Burns occur when the skin is exposed to heat or chemicals, for example fire, sunburn, friction, acid, bleach or garden chemicals. Scalds happen when the skin is exposed to hot fluids, for example boiling water, steam or hot fat.
Burns and scalds are usually divided into three categories depending on how much damage they cause to the skin and underlying tissues:
First-degree or minor burns are superficial and affect only the outer layer of the skin, making it red and sore.
Second-degree or partial thickness burns extend below the surface of the skin, the skin looks raw and blisters form.
Third-degree or full thickness burns damage the entire layer of the skin and underlying tissues to affect nerves muscle and fat, the skin looks pale, waxy and charred.
First-degree burns can be treated at home and usually heal in seven to ten days. Second- and third-degree burns are much more serious and require medical attention as there is a risk of infection and shock (dangerously low drop in blood pressure) developing.
Almost all burns and scalds occur as the result of accidents, and nearly all of these involve children although the elderly are also at risk. The Royal Society for the Prevention of Accidents (RoSPA) estimates that more than 37,000 under-16s go to hospital each year seeking treatment for a burn or scald, and ten children under the age of five are admitted to hospital each day as the result of a burn or scald.
All burns and scalds cause intense pain at the site of the injury. First-degree burns can be recognised by slight swelling and redness. In second-degree burns, the skin looks red raw and blisters will appear. Black, charred or waxy skin indicates a third-degree burn and that the burn is serious. Serious burns can cause shock. Symptoms of shock include shortness of breath, dizziness, a rapid pulse and, in severe cases, unconsciousness or even death. If you scald your mouth or throat, there may be a swelling, which can make breathing difficult. Sadly many burns and scalds leave children badly scarred for life and often requiring plastic surgery.
Minor burns – bathe the area in cold running water for at least 10 minutes and carefully clean away any dirt from the damaged area of skin while the wound is still underwater. Gently remove any jewellery or clothing. Do not break blisters or interfere with the burn, do not apply any creams, lotions, butter or fat and do not use any adhesive dressings. Cover the area with a clean plastic bag or cling film to keep the area clean and help avoid infection.
Fortunately, most burns caused in the home are minor and will heal within a few days. As a secondary step, antiseptic creams and special sterile bandages available from the pharmacy will help soothe the burn, kill bacteria and protect the damaged skin. Simple pain killers such as paracetamol may be used for pain relief.
Severe burns and scalds – the priority is to cool the injury and seek medical advice as soon as cooling has begun, but this should not delay transmission of the person to hospital. Bathe the area in cold water for at least 10 minutes. While cooling the burn, check the person’s breathing and level of consciousness and be prepared to resuscitate. Do not remove anything sticking to the burn, do not touch the burn or burst blisters. Do not apply any creams, lotions, butter or fat to the burn. Remove any jewellery, watches and burnt clothing from the injured area provided they are not sticking to the burn. Wrap the burnt area in a clean plastic bag or cover with cling film to prevent infection as a temporary measure while you are waiting for medical help to arrive or as you go to the Accident and Emergency department of your local hospital.
Chemical burns – if the burn is caused by a household chemical rinse the area immediately in cold running water for at least 20 minutes. Do not apply any creams or lotions, but try to remove any jewellery or clothing from the area. If the substance is swallowed and the person develops difficulty breathing or signs of shock, lie them on the floor, loosen any tight clothing, check that their airway is clear, keep them warm with a blanket and call for an ambulance. Be prepared to resuscitate. Show the container to ambulance staff.
Prevention – most accidents involving burns and scalds can be prevented by a few simple safety precautions. In the bathroom, fit thermostats to set bath water temperature to a maximum of 48°C, run cold water into the bath before adding hot water and do not leave children unsupervised in the bath. In the kitchen, fit a guard around the cooker, place pots and pans on the back rings and turn the handles so they cannot be pulled over, keep the flex short on kettles and irons and make sure the flex does not hang over work surfaces. Around the home, fit smoke alarms, use guards in front of fires and heaters, place hot drinks on a firm base and out of the reach of children, avoid passing hot drinks over the heads of children, keep household bleach, cleaning fluids and garden chemicals in a locked cupboard and use child-resistant tops on bottles.
When to consult your pharmacist
If you have a minor burn or scald apply first-aid, then talk to your pharmacist. There is a large variety of antiseptic liquids, creams and sprays that the pharmacist may recommend to help avoid getting an infection. Special burn dressings can be used that will protect the wound while it is healing, but will not become stuck to it. Simple pain killers such as paracetamol may be used to ease pain.
When to consult your doctor
All second- and third- degree burns carry the risk of shock. Call an ambulance if a burn or scald is severe or if symptoms of shock are observed. All second-degree burns and even bad first-degree burns should be seen and assessed by a doctor as soon as possible. Second-degree burns covering a large area, or burns to the face, hands or across joints, and all third-degree burns require hospital treatment and an ambulance should be called immediately.
Take particular care when children are around fire, barbecues, hot liquids, cookers, radiators, electric fires, irons and anything else that can burn them
There is a myth that putting butter or fat on burns will help them heal - this is not true. Do not use any fat on any burn or scald
Keep an up-to-date first aid box at home and work - check with the pharmacist or St John Ambulance on what should be stored, such as special sterile bandages (see First Aid Section)
Reviewed on 28/09/2009