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by Scholten A

Definition

A burn is damage to the skin and sometimes to the underlying tissues. Burns can range from mild to severe. Some are fatal.

There are four main types of burns:

  • First degree—mild, affect the outer layer of skin
  • Second degree—deeper into the outer layer of skin
  • Third degree—serious, all layers of skin are damaged
  • Fourth degree—very serious, damage goes to nerves, muscle, tendon, and/or bone
Classification of Skin Burns
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Causes

Burns can be caused by:

  • Heat or flame, such as:
    • Hot foods, drinks, water, oil, or grease
    • Direct heat such as stoves, heaters, or curling irons
    • Direct flame
    • Fireworks
  • Chemicals, such as:
    • Cleaning products
    • Battery fluid
    • Pool chemicals
    • Drain cleaners
  • Sunlight (sunburns ) or tanning beds
  • Electricity ( electrical burn )
  • Radiation—nuclear, x-rays or radiation treatments for cancer

Risk Factors

Burns are more common in males, children, and older adults. Other things that raise the risk are:

  • Smoking
  • Alcohol use
  • Illegal drug use
  • Absent or non-working smoke detectors
  • Older housing
  • Not watching children closely
  • Using tap water hotter than 120°F (48.8°C)

Symptoms

Burn symptoms and signs vary. It depends on the type of burn.

First Degree Burn

  • Burned area turns red and is painful
  • The area turns white when pressed
  • There may be swelling but no blistering

Second Degree Burn

  • Blisters
  • The area is moist, red, and weeping—or waxy dry
  • The area may turn white when pressed
  • Usually painful to air and temperature

Third and Fourth Degree Burn

  • Skin can appear waxy white, leathery gray—or charred and blackened
  • May feel deep pressure but no pain

Diagnosis

The doctor will check your symptoms and health history. A physical exam will be done.

Testing is based on how severe the burn is. Tests may include:

  • Blood tests
  • Imaging—to see how deep the burn is, or if it has affected the inside of the body
  • ECG—for electrical burns

Treatment

Burns needs to be treated right away. Treatment depends on the severity and extent of the burn. The goal is to reduce damage to the tissues and prevent infection.

Minor burns are treated with first aid measures—such as cooling and covering the burn.

Serious burns need medical help right away. Treatment may include:

  • CPR and first aid
  • Hospitalization
  • Airway and breathing support—with oxygen or mechanical ventilation
  • Pain medicines
  • Ointments and dressings—to promote healing and prevent infection
  • IV fluids—to replace those lost from the burn
  • Surgery, such as skin grafts—if burns are unlikely to heal
  • Physical therapy—if burns are large

Prevention

Most burns are from accidents. To reduce the risk:

  • Watch children and protect them from hazards, such as:
    • Stove burners, hot water, hot water faucets, and hot food and drinks
    • Matches, lighters, candles, cigarettes
    • Gas, chemicals, and firecrackers
    • Electric cords and outlets
  • Use smoke detectors and make sure they work

RESOURCES

American Burn Association  http://ameriburn.org 

Family Doctor—American Academy of Family Physicians  https://familydoctor.org 

CANADIAN RESOURCES

Canadian Burn Survivors Community  http://canadianburnsurvivors.ca 

Health Canada  https://www.canada.ca 

References

Burns. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/injuries-poisoning/burns/burns. Accessed March 3, 2021.

First aid for burns: Parent FAQ. Healthy Children—American Academy of Pediatrics Healthy Children website. Available at: https://www.healthychildren.org/English/safety-prevention/all-around/Pages/First-Aid-For-Burns.aspx. Accessed March 3, 2021.

Litt JS. Evaluation and management of the burn patient: a case study and review. Mo Med. 2018;115(5):443-446.

Major burns. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/major-burns. Accessed March 3, 2021.

Minor burns. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/condition/minor-burns. Accessed March 3, 2021.

Protect the ones you love: burns. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/SafeChild/Fact%5FSheets/Burns-Fact-Sheet-a.pdf. Accessed March 3, 2021.

Topical treatment and dressing of burns. EBSCO DynaMed. Available at: https://www.dynamed.com/management/topical-treatment-and-dressing-of-burns. Accessed March 3, 2021.

Revision Information

  • Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
  • Review Date: 01/2021
  • Update Date: 03/03/2021