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Skin burns are a common injury that can result from exposure to a number of sources, including fire or hot objects, hot water, steam, chemicals, electricity, friction, radiation, and overexposure to the sun.
The 4 Types of Burns
There are different types of burns. In the past, burns were classified as first, second, third, or fourth degree, but they are currently categorized to better describe which burns require surgical treatment.
- Superficial skin burn (formerly “first-degree burn”): affects only on the top layer of skin
- Superficial partial-thickness burn (formerly “second-degree burn”): affects the top 2 layers of skin, but does not go deep into the second layer
- Deep partial-thickness burn (formerly “third-degree burn”): also affects the top 2 layers of skin, but is deeper than a superficial partial-thickness burn
- Full-thickness burn (formerly “fourth-degree burn”): affects all the layers of the skin and often the fat and muscle underneath
Burn classification can change over a few days. A burn may seem superficial initially, become deeper over time.
Burn wounds need air to heal, which is why applying butter, petroleum jelly, ointment, oil, or grease to a burn is not advised. These substances also trap heat in the burned area which can further damage tissue.
How to Treat a Burn
For minor burns that do not require a doctor visit, there are steps you can take to help prevent infection, treat pain, and help the burn heal more quickly. Home treatment for minor burns includes:
- Clean the burn
- Remove clothing covering the area
- If clothing sticks to the burn, see a doctor
- Wash the burned area gently with plain soap and cool water
- It is not necessary to disinfect the skin with alcohol, iodine, or other cleansers
- Remove clothing covering the area
- Cool the burn
- After cleaning, use a cool compress or cool cloth on the skin
- Do not use ice on burned skin
- Prevent infection
- Wash the burn daily with plain soap and cool water
- If the burn is deeper than the top layer of skin, to help prevent infection apply topical aloe vera or a topical antibiotic such as bacitracin
- Do not apply home remedies such as mustard, egg whites, mayonnaise, lavender oil, or toothpaste to skin burns
- If the burn blisters, cover it with a clean, non-stick bandage and change the bandage once or twice daily as needed
- Do not pop blisters, due to increased risk of infection
- Treat pain
- Over-the-counter (OTC) pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may be used
- If pain is not controlled with OTC pain relievers, contact your doctor
- Topical numbing medications should not be used regularly on burn wounds, because they may irritate the skin
- Elevate burns on the hand or foot to above the level of the heart to help prevent swelling and pain
- Avoid scratching a burn
- Scratching can increase the risk of infection
- Over-the-counter (OTC) antihistamines such as diphenhydramine (Benadryl) may help relieve itch
- Use a moisturizing lotion to hydrate skin and prevent dryness that can cause itching
- Tetanus prevention
- Get a tetanus booster vaccine if you have not had a tetanus shot in the past five years and the burn is superficial partial-thickness (formerly called second-degree) or deeper
More serious burns need to be treated by a doctor, and severe burns may require hospitalization or treatment at a burn center.
Medical treatments for severe burns may include:
- Intravenous (IV) fluids
- Pain medications
- Topical burn creams and ointments
- Antibiotics for infection
- Ultrasound mist therapy to clean wound tissue
- Anti-anxiety medications
- Wound dressings
- Physical therapy if burns cover a large area or a joint
- Skin grafts
- Plastic surgery
What Are Symptoms of a Burn?
Symptoms of a burn depend on how badly the skin is burned:
- Superficial skin burn
- Skin dryness, redness, and pain
- When the burn is pressed, it turns white
- Superficial skin burns heal in three to six days and do not leave a scar
- Superficial partial-thickness burn
- Skin is painful to a light touch or air temperature changes
- Skin redness
- Skin leaks fluid
- Blisters may occur
- When the burn is pressed, it turns white
- Superficial partial-thickness burns take one to three weeks to heal, and the area of skin that was burned might be darker or lighter than it used to be when it heals
- May or may not leave a scar
- Deep partial-thickness burn
- Hurts when pressed hard
- Does not turn white when pressed
- Blisters
- Deep partial-thickness burns take more than three weeks to heal
- Will probably leave a scar
- Full-thickness burn
- Does not usually hurt
- Skin can be white, gray, or black
- Skin feels dry
- Treated with medications, surgery, and possible hospitalization
How Is a Burn Diagnosed?
A burn is diagnosed with a patient history of the injury and a skin examination to determine the severity of the burn.
In more severe cases, a doctor may send patients to a burn center. The American Burn Association recommends patients be sent to a burn center in the following circumstances:
- A burn covers more than 10% of the total body surface area
- Deep partial-thickness burn ("third-degree burn")
- Electrical burns, including lightning injury
- Chemical burns
- Inhalation burns
- The burn involves the face, hands, feet, genitalia, or major joints
- Burn injury in patients with preexisting medical conditions that could complicate treatment or recovery
- Burns are accompanied by trauma (such as fractures) in which the burn injury has a higher risk of death. (If trauma is a greater risk the patient may be initially stabilized in a trauma center before being transferred to a burn unit.)
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https://www.uptodate.com/contents/skin-burns-beyond-the-basics?search=burns&topicRef=15740&source=see_link#H9
https://www.emergencyphysicians.org/article/know-when-to-go/burns
http://ameriburn.org/wp-content/uploads/2017/05/burncenterreferralcriteria.pdf
https://www.uptodate.com/contents/overview-of-the-management-of-the-severely-burned-patient?search=burn%20treatment&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H14168772