Burns: How Serious and Ways to Treat
What is a burn?
Burns are injuries to skin that has come into contact with a heat source. They happen when skin gets too close to fire, hot objects, electricity, certain chemicals, hot liquids or steam, or radiation (including sunlight).
Sometimes, the injury extends down into the deeper soft tissues. Different degrees of burns (first, second, and third) correspond with how bad the damage is and determine how they should be treated.
What are 3 types of burns?
When there is a blister on the burn, you should not pop the blister or remove it. The roof of the blister acts as a natural band aid for the underlying skin. —Dr. Lauren Levy
First-degree burns only damage the outermost layer of skin. They will hurt and make your skin red. But only the top layer of skin (the epidermis) is damaged. You won’t have any blisters. These are the least worrisome and can usually be treated at home.
Second-degree burns damage the deeper layer of skin so they involve the epidermis and the second layer (dermis). They will be pink or red and will blister. The area will probably swell, and look shiny and wet. It’s very painful, especially when touched. These need more care. You might have to go to the emergency room if the burn covers a large area of your body.
Third-degree burns go through the entire thickness of the skin and damage the tissue underneath (like muscle or bones). They damage skin so deeply that it actually won't be red. It might look black, brown, white, or yellow. It may not even hurt, but instead may feel numb. That's usually because the nerve endings are so damaged. For any suspected third-degree burn, you must go right to the emergency room to have it treated. You may be sent to a specialized burn center if the burns are severe.
Causes of burns
Burns happen when something hot damages your skin—either the top layer or the tissue underneath. They can be caused by:
- Heated objects
- Heated liquids or steam
- Radiation (including sunlight)
Sun protection with sunscreen will help make the scar less visible. —Dr. Levy
Move away from the source of the burn as quickly as possible. Rinse it with a lot of lukewarm water. Ideally soak it for 15 to 30 minutes. Do not rinse with warm or hot water. Do not apply ice unless you have a sunburn. Do not use soap or any cleaning solution. Keep the area clean and dry after the soak.
If you can easily do so, take off any loose clothing or jewelry that’s near the affected area. If anything is burned or stuck onto the skin, do not touch it.
Go straight to the ER or call 911 if the burn:
- Is from any chemical, electrical, or radiation exposure.
- Is larger than the palm of your hand.
- Is on your hands, feet, face, genitals, or on any major joint. (Unless it is a very small first-degree burn.)
- Charred your skin—the skin will appear white or black and will feel numb.
- Uncovered the layer of tissue under the skin—you would see muscle or bone peeking through the skin.
- Exposed you to chemicals or smoke, making it hard to breathe or cause any significant coughing, or changed the sound of your voice.
A first-degree burn can be treated at home. Do not ice it. Rinse it right away with a lot of room-temperature or cool water—not cold water (and not warm or hot water). Rinse it ideally for 15 to 30 minutes. Do not use soap or any cleaning solution. Very gently dry the area.
Gently apply an over-the-counter ointment like Vaseline or Aquaphor. Wrap it loosely to avoid putting pressure on burned skin. Bandaging keeps air off the area, reduces pain, and protects your skin.
If there is significant oozing of pus or yellow crust, your burn may be infected and you should see your doctor. They may prescribe a prescription antibiotic ointment like bactroban or silver sulfadiazine cream.
More serious burns
If you have a second-degree burn, or it’s first-degree and larger than your palm, go to the ER for treatment. If it’s mild or moderate, the hospital staff will clean and inspect it. Do not puncture a blister unless it is large, painful, or likely to be further irritated. The fluid-filled blister keeps the underlying skin clean, which prevents infection and promotes healing.
For some second- or third-degree burns, you might need a procedure called debridement. That’s when the doctor gets rid of the dead tissue to help with healing, according to the National Institutes of Health. Some kinds of debridement cause little pain but mechanical and sharp debridement can hurt. If you're getting mechanical debridement, you may be given pain medication.
If you have a third-degree burn or second-degree burn covering a large area, the doctor might give you IV fluids to help your skin rehydrate and keep your water and salt balance in your body stable.
You might need to stay in the hospital while it heals. You might need a skin graft. This is a surgery where they cover your burn with healthy skin from you or a donor.
If the burns make it hard to breathe, the doctor might give you a breathing tube or a ventilator. If large burns are restricting your movement or breathing, they will perform an emergency escharotomy to cut away that tough skin.
Most burns are mild and will not require follow-up. You need to keep the skin clean and dry so it doesn’t get infected. You can gently put ointment on and can take over-the-counter pain medication like acetaminophen (Tylenol) or ibuprofen (Motrin) to help manage pain. Call your doctor or go to the ER if it becomes:
- More red or swollen
- More painful
- Starts draining fluid
- If you start having fevers or chills
If you have a chronic scar from a burn, you are at a small risk of developing skin cancer in the scar (squamous cell carcinoma). You should see your dermatologist yearly to have your wound checked. If you notice any lumps or bumps in the scar you should have your doctor check it out. —Dr. Levy
Daniel DuPont is from Wayne, Pennsylvania. He is a member of the Emergncy Residency class of 2022 Perelman School of Medicine at the University of Pennsylvania.