Skin burns

Skin burns

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Official reprint from UpToDate® www.uptodate.com ©2015 UpToDate®

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2015 UpToDate, Inc. Patient information: Skin burns (Beyond the Basics) Authors Arek Wiktor, MD David Richards, MD, FACEP

Section Editor Ron M Walls, MD, FRCPC, FAAEM

Deputy Editor Jonathan Grayzel, MD, FAAEM

All topics are updated as new evidence becomes available and our peer review process is complete.

Literature review current through: Nov 2015. | This topic last updated: Oct 15, 2015.

SKIN BURNS OVERVIEW — Skin burn injuries are common, with over one million burn injuries occurring every year in the United States. Skin burns can result from exposure to several possible sources, including hot water or steam, hot objects or flames, chemicals, electricity, or overexposure to the sun.

Most skin burns are minor and can be managed at home. However, it is important to know the signs of a more serious skin burn, which should be evaluated and treated by a healthcare provider. Moderate to severe burns can cause a number of serious complications and usually require urgent treatment.

This article discusses skin burns caused by steam, hot water or other hot objects in the home, including which burns can be treated at home and those that require evaluation and treatment by a healthcare provider. Other topics that discuss burns are also available. (See "Emergency care of moderate and severe thermal burns in adults" and "Treatment of minor thermal burns" and "Topical chemical burns" and "Environmental and weapon-related electrical injuries".)

SKIN BURN SYMPTOMS When to seek help — If you have any of the following, you should call your healthcare provider. ● If the burn involves the face, hands or fingers, genitals, or feet ● If the burn is on or near a joint (knee, shoulder, hip) ● If the burn encircles a body part (arm, leg, foot, chest, finger) ● If the burn is large (greater than 3 inches or 7.5 cm) or deep (any partial-thickness or full thickness). If you have any doubt about whether the burn is large or deep, it is best to see a healthcare provider. (see 'Burn type' below) ● If the victim is young (less than five years) or older than 70 years ● If there are signs of skin infection, such as increasing redness, pain, pus-like discharge, or temperature greater than 100.4ºF or 38ºC Burn type — Burns were previously classified as first, second, third, or fourth degree, based on the thickness of the skin burned. This system is being replaced with a system that better describes which burns require surgical treatment.

The classification of a burn can change over the first few days. This means that a burn may appear superficial initially, and then become deeper over time. If you are unsure how deeply your skin is burned, contact a healthcare provider.

Superficial skin burns — Superficial skin burns, previously called first-degree burns, involve only the top layer of skin, are painful, dry, and red, and turn white when pressed (picture 1). Superficial burns generally heal in three to six days without scarring. Non-blistering sunburns are a good example of a superficial skin burn. http://www.uptodate.com/contents/skin-burns-beyond-the-basics?topicKey=PI%2F7626&elapsedTimeMs=2&view=print&displayedView=full

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Superficial partial-thickness skin burns — Superficial partial-thickness skin burns, previously called seconddegree burns, involve the top two layers of skin, are painful with air movement or air temperature changes, are red and seep fluid, usually form blisters, and turn white when pressed (picture 2). Superficial partial thickness skin burns heal within seven to 21 days. The burned area may permanently become darker or lighter in color but a scar does not usually form.

Sunburns that blister after several hours are good examples of superficial partial-thickness burns.

Deep partial-thickness skin burns — Deep partial-thickness skin burns, previously called third-degree burns, extend deeper into the skin, are painful with deep pressure, almost always form blisters, and do not turn white with pressure. Deep partial-thickness skin burns take more than 21 days to heal and usually develop a scar, which may be severe.

Burns that blister immediately are deep partial-thickness burns. A blister that persists for several weeks is also considered a deep partial-thickness burn.

Full-thickness burns — Full-thickness skin burns, previously called fourth-degree burns, extend through all layers of the skin, completely destroying the skin. The burned area usually does not hurt, is a waxy white to leathery gray or charred black color, and the skin is dry and does not blanch when touched (picture 3). Full-thickness burns cannot heal without surgical treatment and scarring is usually severe.

SKIN BURN TREATMENT — Small superficial or superficial partial-thickness burns can often be treated at home.

However, burns that are larger or deeper should be evaluated by a healthcare provider.

Home treatment of skin burns should include cleaning the area, immediately cooling it, preventing infection, and managing pain.

Clean the area — Remove any clothing from the burned area. If clothing is stuck to the skin, do not try to remove it and seek emergency medical care.

Wash the burned skin gently with cool tap water and plain soap. It is not necessary to disinfect the skin with alcohol, iodine, or other cleansers.

Cool the area — After cleaning the skin, you may apply a cold compress to the skin or soak the area in cool (not ice) water for a brief period of time to reduce pain and reduce the extent of the burn. Avoid placing ice directly on the skin because this can damage the skin further.

Prevent infection — To prevent infection in partial-thickness and more severe burns, apply aloe vera or an antibiotic cream, such as bacitracin. Do not apply ointments or other substances to skin burns. Keep burns clean by washing the burned area daily with soap (does not need to be antibacterial) and water.

Minor burns may be covered with a bandage or dressing if you wish; burns that form blisters should be covered with a clean bandage or dressing. A bandage that does not stick to the skin (labeled as "non-stick") is preferred for the first layer. Change the dressing once or twice per day, as needed.

Do not try to break open skin blisters with a needle or fingernail because this can increase the risk of skin infection. The blister will open and drain on its own.

Tetanus prevention — If you have not had a tetanus shot in the past five years and your burn is superficial partialthickness or deeper, you need a tetanus booster vaccine. (See "Patient information: Adult vaccines (Beyond the Basics)".)

Treat pain — Elevating burns on the hand or foot above the level of the heart can help to prevent swelling and pain.

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You may take a non-prescription pain medication, such as acetaminophen (eg, Tylenol®) or ibuprofen (Advil®, Motrin®) if needed for pain. If your pain is not controlled with these medications, contact your healthcare provider. People with more severe or larger burns may require a prescription pain medication. Topical anesthetic (numbing) agents should not be used regularly on burn wounds, as irritation may occur, and the effects will wear off sooner with prolonged use.

Avoid scratching the skin — Many people are bothered by itching as the burned skin begins to heal. Try to avoid scratching the skin. Use a moisturizing lotion if needed. A non-prescription antihistamine such as diphenhydramine (eg, Benadryl®) may help reduce itching.

SKIN BURN FOLLOW UP — If your burn is not healing, becomes more painful, or appears infected (redness spreading greater than 2 cm from the edge of the burn), you should see a healthcare provider soon.

Most skin burns that are small and superficial will heal within one week and will not usually scar. After a superficial partial-thickness burn, the skin may become darker or lighter in color, but will not usually scar.

PREVENTING SKIN BURNS — Skin burns can often be prevented by making some changes in your home. ● Keep lit candles, matches, and lighters out of the reach of children. ● Do not smoke when sleepy, after taking sedatives or sleeping pills, or after drinking alcohol. ● Do not smoke while on supplemental oxygen. ● Keep hot foods and drinks, irons, and curling irons away from the edge of counters and tables. ● Use a cool-mist humidifier rather than a warm mist or steam humidifier. ● Keep children away from hot stoves, fireplaces, and ovens. Turn pot handles inward and cook on the rear burners when possible. Never carry a child in your arms while cooking. ● Install a smoke detector on each floor of your home. Test the batteries in smoke detectors once per month and change if needed. ● Children's sleepwear should be non-flammable. Sweat pants and loose t-shirts are not as safe as sleepwear.

Cotton sleepwear should fit snugly. ● Set the thermostat on your hot water heater no higher than 120ºF (49ºC). If you cannot adjust your hot water heater, install an anti-scald device on your shower, bath, or faucet. ● Cover car seats, seat belts, and strollers with a blanket or towel if you must leave them in a parked car on a hot day. Be careful when placing the child in the seat because metal and vinyl can become very hot. ● Prevent sunburn by applying sunscreen liberally and staying out of the sun when possible. Sunburn prevention is discussed in detail separately. (See "Patient information: Sunburn prevention (Beyond the Basics)".)

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. http://www.uptodate.com/contents/skin-burns-beyond-the-basics?topicKey=PI%2F7626&elapsedTimeMs=2&view=print&displayedView=full

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Patient information: Sunburn (The Basics) Patient information: Skin burns (The Basics) Patient information: Acute compartment syndrome (The Basics) Patient information: Electrical burns (The Basics) Patient information: Blisters (The Basics) Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient information: Adult vaccines (Beyond the Basics) Patient information: Sunburn prevention (Beyond the Basics) Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Emergency care of moderate and severe thermal burns in adults Environmental and weapon-related electrical injuries Topical chemical burns Treatment of minor thermal burns The following organizations also provide reliable health information. ● Kids Health (http://kidshealth.org/parent/firstaid_safe/emergencies/burns.html) ● American Burn Association (www.ameriburn.org) ● Medline Plus (http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm, available in Spanish) [1,2] Use of UpToDate is subject to the Subscription and License Agreement.

REFERENCES 1. Lowell G, Quinlan K, Gottlieb LJ. Preventing unintentional scald burns: moving beyond tap water. Pediatrics 2008; 122:799.

2. Turner C, Spinks A, McClure R, Nixon J. Community-based interventions for the prevention of burns and scalds in children. Cochrane Database Syst Rev 2004; :CD004335.

Topic 7626 Version 16.0

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GRAPHICS Superficial burn

Superficial burns are red, and they turn white when you press them.

Courtesy of Eric D Morgan and William F Miser, MD. Graphic 60417 Version 3.0

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Superficial partial-thickness burn

Superficial partial-thickness burns can form blisters, and they turn white when you press them. They might feel moist and leak fluid.

Courtesy of Eric D Morgan and William F Miser, MD. Graphic 65552 Version 2.0

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Full-thickness burn

Full-thickness burns are white, gray, or black, and do not turn pale when touched. The burned skin cannot feel anything, so it does not hurt when you touch it.

Courtesy of Eric D Morgan, MD and William F Miser, MD. Graphic 63587 Version 3.0

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Disclosures Disclosures: Arek Wiktor, MD Nothing to disclose. David Richards, MD, FACEP Nothing to disclose. Ron M Walls, MD, FRCPC, FAAEM Other Financial Interest: Airway Management Education Center [Healthcare provider education and resources (Cook Melker Universal Cricothyrotomy kit, the Difficult Airway course)]. Jonathan Grayzel, MD, FAAEM Nothing to disclose.

Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence.

Conflict of interest policy

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