Burns and scalds

Burns and scalds are damage to the skin usually 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 may cause:

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

The amount of pain you feel is not 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
• remove any clothing or jewellery that's near the burnt area of skin, including babies' nappies, but do not move anything that's stuck to the skin
• cool the burn with cool or lukewarm running water for 20 to 30 minutes – do not use ice, iced water, or any creams or greasy substances like butter
• make sure the person keeps warm by using a blanket, for example, but take care not to rub it against the burnt area
• after cooling the burn, 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
• raise the affected area if possible – this helps to reduce swelling
• if it's an acid or chemical burn, dial 112, 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 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, neck, hands, feet, any joints or genitals

If someone has breathed in smoke or fumes, they should also get 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 10 years old, 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 about:

• recovering from burns and scalds
• complications of 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 3 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 4 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. The texture of the skin may also be leathery or waxy. It may also be painless

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

Read more about preventing burns and scalds.

Further advice

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

• speak to a GP

 Treatment Burns and scalds 

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's 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 do not try to remove anything that's 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're cooling a large burnt area, particularly in young children and elderly people.
• Cover the burn with cling film. Lay the cling film 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.
• Raise the affected area, if possible. This will help to reduce swelling.

When to go to hospital

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

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

• large burns bigger than the size of the affected person's hand
• deep burns of any size that cause white or charred skin
• burns on the face, neck, hands, feet, any joints, or genitals
• all chemical and electrical burns
• any other injuries that need treating
• any signs of shock – symptoms include cold, clammy skin, sweating, rapid, shallow breathing, and weakness or dizziness

You should also go to hospital if you or the person who has been burned:

• is under the age of 10
• 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 get medical attention at hospital.

Some symptoms may be delayed, and can include:

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

You should also go to A&E if you have been injured intentionally, or think someone has been injured intentionally.

See 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's 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're helping someone else, put on appropriate protective clothing, such as gloves, 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

Follow this advice for sunburn:

• 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 for 10 minutes to cool down the burnt area of skin.
• Apply aftersun lotion to the affected area to moisturise, cool and soothe it. Don't 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 the age of 16.
• 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 40C (98.6 to 104F) or above. Symptoms include dizziness, a rapid pulse or vomiting.

If a person with heat exhaustion is taken to a cool place quickly, 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 112 for an ambulance.

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

 Recovery Burns and scalds 

How long it takes to recover from a burn or scald depends on how serious it is and how it's treated. If the wound becomes infected, get 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 first aid for 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 as 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'll 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's a chance soil 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's moderate or 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.

See plastic surgery techniques for more information about this.

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

Blisters

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

If your burn has caused a blister, you should get 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 a burn, you should try to avoid exposing the damaged skin to direct sunlight as this may cause it to blister.

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

It's 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 2 years after the injury, but it's still very important to apply a high-factor sun cream (SPF 30 or above) and stay out of the midday sun.

When to get further medical advice

• 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 2 weeks

 Complications Burns and scalds 

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

Shock

After a serious injury, it's possible to go into shock. Shock is a life-threatening condition that occurs when there's 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 112 and ask for an ambulance if you think someone who's 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're 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 112 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's burst, it may become infected if it's not kept clean.

Seek medical attention for any burn that causes a blister.

Your wound may be infected if:

• it's 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

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's healed by:

• applying an emollient, such as aqueous cream or emulsifying ointment, every day until the burn is no longer dry or itchy. This could take 3 to 6 months
• using sunscreen with a high sun protection factor (SPF) to protect the healing area from the sun when you're 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.

 Prevention Burns and scalds 

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 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 15 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
• do not 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 6 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 sunscreens 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