Introduction

Burns and scalds
Burns and scalds

Burns and scalds are damage to the skin caused by heat. Both are treated in the same way.

A burn is caused by dry heat - by an iron or fire, for example. A scald is caused by something wet, such as hot water or steam.

Burns can be very painful and can cause:

  • red or peeling skin
  • blisters
  • swelling
  • white or charred skin

The amount of pain you feel isn't always related to how serious the burn is. Even a very serious burn may be relatively painless.

Treating burns and scalds

To treat a burn, follow the first aid advice below:

  • immediately get the person away from the heat source to stop the burning
  • cool the burn with cool or lukewarm water for 20 minutes - do not use ice, iced water, or any creams or greasy substances like butter
  • remove any clothing or jewellery that is near the burnt area of skin, including babies' nappies, but do not move anything that is stuck to the skin
  • make sure the person keeps warm by using a blanket, for example, but take care not to rub it against the burnt area
  • cover the burn by placing a layer of cling film over it - a clean plastic bag could also be used for burns on your hand
  • use painkillers such as paracetamol or ibuprofen to treat any pain
  • if the face or eyes are burnt, sit up as much as possible, rather than lying down - this helps to reduce swelling
  • if it's an acid or chemical burn, dial 999, carefully try to remove the chemical and any contaminated clothing, and rinse the affected area using as much clean water as possible

Read more about treating burns and scalds.

When to get medical attention

Depending on how serious a burn is, it may be possible to treat it at home.

For minor burns, keep the burn clean and do not burst any blisters that form.

More serious burns will require professional medical attention.

You should go to a hospital A&E department for:

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

If someone has breathed in smoke or fumes, they should also seek medical attention.

Some symptoms may be delayed and can include:

  • coughing
  • a sore throat
  • difficulty breathing
  • facial burns

People at greater risk from the effects of burns, such as children under five years old and pregnant women, should also get medical attention after a burn or scald.

The size and depth of the burn will be assessed and the affected area cleaned before a dressing is applied. In severe cases, skin graft surgery may be recommended.

Read more information about recovering from burns and scalds.

Types of burn

Burns are assessed by how seriously your skin is damaged and which layers of skin are affected.

Your skin has three layers:

  • the epidermis - the outer layer of skin
  • the dermis - the layer of tissue just beneath, which contains blood capillaries, nerve endings, sweat glands and hair follicles
  • the subcutaneous fat, or subcutis - the deeper layer of fat and tissue

There are four main types of burn, which tend to have a different appearance and different symptoms:

  • superficial epidermal burn - where the epidermis is damaged; your skin will be red, slightly swollen and painful, but not blistered
  • superficial dermal burn - where the epidermis and part of the dermis are damaged; your skin will be pale pink and painful, and there may be small blisters
  • deep dermal or partial thickness burn - where the epidermis and the dermis are damaged: this type of burn makes your skin turn red and blotchy; your skin may be dry or moist, and become swollen and blistered, and it may be very painful or painless
  • full thickness burn - where all 3 layers of skin (the epidermis, dermis and subcutis) are damaged; the skin is often burnt away and the tissue underneath may appear pale or blackened, while the remaining skin will be dry and white, brown or black with no blisters, and the texture of the skin may also be leathery or waxy

Preventing burns and scalds

Many severe burns and scalds affect babies and young children.

Examples of things you can do to help reduce the likelihood of your child having a serious accident at home include:

  • keeping your child out of the kitchen whenever possible
  • testing the temperature of bath water using your elbow before you put your baby or toddler in the bath
  • keeping matches, lighters and lit candles out of young children's sight and reach
  • keeping hot drinks well away from young children

Further advice

If you need advice about a burn or scald, you can:

Use the local services to find minor injury units near you.

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Treatment

Appropriate first aid must be used to treat any burns or scalds as soon as possible. This will limit the amount of damage to your skin.

You can apply the following first aid techniques to yourself or another person who has been burnt.

First aid for burns

  • Stop the burning process as soon as possible. This may mean removing the person from the area, dousing flames with water or smothering flames with a blanket. Do not put yourself at risk of getting burnt as well.
  • Remove any clothing or jewellery near the burnt area of skin, including babies' nappies. But don't try to remove anything that is stuck to the burnt skin, as this could cause more damage.
  • Cool the burn with cool or lukewarm running water for 20 minutes, as soon as possible after the injury. Never use ice, iced water, or any creams or greasy substances like butter.
  • Keep yourself or the person warm. Use a blanket or layers of clothing, but avoid putting them on the injured area. Keeping warm will prevent hypothermia, where a person’s body temperature drops below 35C (95F). This is a risk if you are cooling a large burnt area, particularly in young children and elderly people.
  • Cover the burn with cling film. Put the cling film in a layer over the burn, rather than wrapping it around a limb. A clean clear plastic bag can be used for burns on your hand.
  • Treat the pain from a burn with paracetamol or ibuprofen. Always check the manufacturer’s instructions when using over-the-counter medication. Children under 16 years of age should not be given aspirin.
  • Sit upright as much as possible if the face or eyes are burnt. Avoid lying down for as long as possible, as this will help reduce swelling.

When to go to hospital

Once you have taken these steps, you will need to decide whether further medical treatment is necessary. 

Go to a hospital accident and emergency (A&E) department for:

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

Also get medical help straight away if the person with the burn:

  • has other injuries that need treating
  • is going into shock - signs include cold, clammy skin, sweating, rapid, shallow breathing and weakness or dizziness
  • is pregnant
  • is over 60 years of age
  • is under five years of age
  • has a medical condition, such as heart, lung or liver disease, or diabetes
  • has a weakened immune system (the body’s defence system), for example because of HIV or AIDS or because they're having chemotherapy for cancer

If someone has breathed in smoke or fumes, they should also seek medical attention.

Some symptoms may be delayed and can include:

  • coughing
  • a sore throat
  • difficulty breathing
  • singed nasal hair
  • facial burns.

Read more about recovering from burns and scalds for information on how serious burns are treated.

Electrical burns

Electrical burns may not look serious, but they can be very damaging. Someone who has an electrical burn should seek immediate medical attention at an A&E department.

If the person has been injured by a low-voltage source (up to 220 to 240 volts) such as a domestic electricity supply, safely switch off the power supply or remove the person from the electrical source using a material that doesn't conduct electricity, such as a wooden stick or a wooden chair.

Do not approach a person who is connected to a high-voltage source (1,000 volts or more).

Acid and chemical burns

Acid and chemical burns can be very damaging and require immediate medical attention at an A&E department.

If possible, find out what chemical caused the burn and tell the healthcare professionals at A&E.

If you are helping someone else, put on appropriate protective clothing and then:

  • remove any contaminated clothing on the person
  • if the chemical is dry, brush it off their skin
  • use running water to remove any traces of the chemical from the burnt area

Sunburn

In cases of sunburn, follow the advice below:

  • If you notice any signs of sunburn, such as hot, red and painful skin, move into the shade or preferably inside.
  • Take a cool bath or shower to cool down the burnt area of skin.
  • Apply aftersun lotion to the affected area to moisturise, cool and soothe it. Do not use greasy or oily products.
  • If you have any pain, paracetamol or ibuprofen should help relieve it. Always read the manufacturer’s instructions and do not give aspirin to children under 16 years of age.
  • Stay hydrated by drinking plenty of water.
  • Watch out for signs of heat exhaustion or heatstroke, where the temperature inside your body rises to 37 to 40°C (98.6 to 104°F) or above. Symptoms include dizziness, a rapid pulse or vomiting.

If a person with heat exhaustion is taken quickly to a cool place, given water to drink and has their clothing loosened, they should start to feel better within half an hour.

If they don’t, they could develop heatstroke. This is a medical emergency and you’ll need to call 999 for an ambulance.

Read more information about the complications of burns and scalds.

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Recovery

How long it takes to recover from a burn or scald depends on how serious it is and how it is treated. If the wound becomes infected, seek further medical attention.

Burns that don't need medical attention

If your burn or scald is mild and treated at home, it normally heals without the need for further treatment.

Read more about how to treat burns and scalds.

While the skin heals, keep the area clean and do not apply any creams or greasy substances. Do not burst any blisters because this can lead to infection.

If you have scalded the inside of your mouth by drinking something hot, try to avoid things that can irritate the scalded area, such as hot and spicy food, alcohol and smoking, until the area heals.

Mild burns or scalds that only affect the uppermost layer of skin (superficial epidermal burns) usually heal in about a week without any scarring.

Burns that need medical attention

If you have a burn or scald that requires medical treatment, it will be assessed to determine the level of care required.

The healthcare professional treating you will:

  • assess the size and depth of the burn by examining the area
  • clean the burn, being careful not to burst any blisters
  • cover the burn with a sterile dressing (usually a pad and a gauze bandage to hold it in place)
  • offer you pain relief, if necessary (usually paracetamol or ibuprofen)

Depending on how the burn happened, you may be advised to have an injection to prevent tetanus, a condition caused by bacteria entering a wound.

For example, a tetanus injection may be recommended if there is a chance that soil has got into the wound.

Your dressing will be regularly checked for signs of infection. It'll also be regularly changed until the burn's completely healed.

Minor burns affecting the outer layer of skin and some of the underlying layer of tissue (superficial dermal burns) normally heal in around 14 days, leaving minimal scarring.

If the burn is moderate to severe, you may be referred to a specialist burn care service.

In some cases, it may be necessary to have surgery to remove the burnt area of skin and replace it with a skin graft taken from another part of your body.

More severe and deeper burns can take months or even years to fully heal, and will usually leave some visible scarring.

Blisters

Expert opinion is divided over the management of blisters that are caused by burns. But it is recommended that you should not burst any blisters yourself.

If your burn has caused a blister, you should seek medical attention.

The blister will probably remain intact, although some burns units at hospitals follow a policy of deroofing blisters. Deroofing means removing the top layer of skin from the blister.

In some cases, a needle may be used to make a small hole in the blister to drain the fluid out.

This is known as aspiration and may be carried out on large blisters or blisters that are likely to burst.

Your healthcare professional will advise you about the best way to care for your blister and what type of dressing you should use.

Exposure to the sun

During the first few years after your burn, you should try to avoid exposing the damaged skin to direct sunlight as this may cause it to blister.

It is especially sensitive during the first year after the injury. This also applies to a new area of skin after a skin graft.

It is important to keep the area covered with cotton clothing. If the burn or scald is on your face, wear a peaked cap or wide-brimmed hat when you're out in the sun.

Total sun block (for example, one with a sun protection factor, SPF, of 50) should be used on all affected areas.

The area can be exposed to sunshine again around 3 years after the injury, but it is still very important to apply a high-factor suncream (SPF 25 or above) and stay out of the midday sun.

When to seek further medical advice

Whether your burn required medical attention or not, you should seek medical advice if:

  • the wound becomes painful or smelly
  • you develop a high temperature of 38C or higher
  • the dressing becomes soaked with fluid leaking from the wound
  • the wound hasn't healed after two weeks
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Complications

Burns and scalds can sometimes lead to further problems, including shock, heat exhaustion, infection and scarring.

Shock

After a serious injury, it is possible to go into shock. Shock is a life-threatening condition that occurs when there is an insufficient supply of oxygen to the body.

It's possible to go into shock after a serious burn.

Signs and symptoms of shock include:

  • a pale face
  • cold or clammy skin
  • a rapid pulse
  • fast, shallow breathing
  • yawning
  • unconsciousness

Dial 999 and ask for an ambulance if you think that someone who has been seriously injured is going into shock.

While you wait for the ambulance:

  • lay the person down (if their injuries allow it) and raise and support their legs
  • use a coat or blanket to keep them warm, but do not cover their face or the burnt area
  • do not give them anything to eat or drink

Heat exhaustion and heatstroke

Heat exhaustion and heatstroke are 2 heat-related health conditions that happen when the temperature inside your body rises to 37 to 40C or above.

Both heat exhaustion and heatstroke can be very serious. They are often caused by being exposed to too much sunlight or heat.

Symptoms of heat exhaustion and heatstroke include:

  • extreme tiredness and lack of energy
  • dizziness or fainting
  • feeling sick or vomiting
  • rapid pulse
  • headache
  • muscle pain
  • irritability
  • confusion

If a person with heat exhaustion is taken quickly to a cool place, given water to drink and has their clothing loosened, they should start to feel better within half an hour.

If they don’t, they could develop heatstroke. This is a medical emergency and you’ll need to call 999 for an ambulance.

Read more about what to do if someone has heat exhaustion or heatstroke.

Infection

Wounds can become infected if bacteria get into them. If your burn or scald has a blister that has burst, it may become infected if it is not kept clean.

Seek medical attention for any burn that causes a blister.

Your wound may be infected if:

  • it is uncomfortable, painful or smelly
  • you have a high temperature of 38C or higher
  • you have signs of cellulitis, a bacterial infection that causes redness and swelling of the skin

Seek immediate medical attention if you think your burn has become infected. An infection can usually be treated with antibiotics and painkilling medication, if necessary.

In rare cases, an infected burn can cause blood poisoning (sepsis) or toxic shock syndrome. These serious conditions can be fatal if not treated.

Signs of sepsis and toxic shock syndrome include:

  • a high temperature
  • dizziness
  • vomiting

Scarring

A scar is a patch or line of tissue that remains after a wound has healed. Most minor burns only leave minimal scarring.

You can try to reduce the risk of scarring after the wound has healed by:

  • applying an emollient, such as aqueous cream or emulsifying ointment, two or three times a day
  • using sunscreen with a high sun protection factor (SPF) to protect the healing area from the sun when you are outside

Psychological impact

Burns and scalds, especially severe ones, can cause long-lasting distress.

After a burn or scald, some people report experiencing:

  • feelings of anxiety and stress
  • low mood and depression
  • a lack of confidence and self-esteem

Some people recovering from a burn may also develop post-traumatic stress disorder (PTSD), which can cause symptoms such as flashbacks, nightmares, and unwanted and intrusive thoughts.

If you experience any of these emotional issues, you should speak to the staff at the burns care service.

They can arrange an appointment with a psychologist with experience of treating people recovering from burns and scalds.

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Prevention

Many severe burns and scalds affect babies and young children. The following advice can help reduce the likelihood of your child having a serious accident.

In the kitchen

  • it's best to keep your toddler out of the kitchen, well away from kettles, saucepans and hot oven doors – you could put a safety gate across the doorway to stop them getting in
  • use a kettle with a short or curly cord to stop it hanging over the edge of the work surface, where it could be grabbed
  • when cooking, use the rings at the back of the cooker and turn saucepan handles towards the back so your child can't grab them

In the bathroom

  • never leave a child under five alone in the bath, even for a moment
  • fit a thermostatic mixing valve to your bath's hot tap to control the temperature
  • put cold water into the bath first, then add the hot water – use your elbow to test the temperature of the water before you put your baby or toddler in the bath

Throughout the home

  • put your iron, hair straighteners or curling tongs out of reach while they cool down after you have finished using them
  • fit fireguards to all fires and heaters
  • keep matches, lighters and lit candles out of young children's sight and reach

Hot drinks

  • keep hot drinks well away from young children – a hot drink can still scald 20 minutes after it was made
  • put hot drinks down before you hold your baby
  • after warming a bottle of milk, shake the bottle well and test the temperature of the milk by placing a few drops on the inside of your wrist before feeding – it should feel lukewarm, not hot
  • don't let your child drink a hot drink through a straw

Preventing sunburn

  • encourage your child to play in the shade (under trees, for example) especially between 11am and 3pm, when the sun is at its strongest
  • keep babies under the age of six months out of direct sunlight, especially around midday
  • cover your child up in loose, baggy cotton clothes, such as an oversized T-shirt with sleeves
  • get your child to wear a floppy hat with a wide brim that shades their face and neck
  • cover exposed parts of your child's skin with sunscreen, even on cloudy or overcast days – most sunscreen designed for children have a sun protection factor (SPF) of between 30 and 50 and are effective against UVA and UVB
  • reapply sunscreen often throughout the day - even water-resistant sunscreens should be reapplied after you come out of the water
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Selected links

NHS Direct Wales Encyclopaedia links 

Blisters

First Aid

Scars

 

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 12/06/2019 10:38:01