Burns and scalds
A burn is damage to the skin from dry heat: an iron, a hob, an open flame. A scald is the same injury caused by hot liquid or steam.
Prescription request online
A doctor will review your case and issue a prescription if medically appropriate.
Talk to a doctor online
Discuss your symptoms and possible next steps with a doctor online.
On this page
Medicines commonly prescribed for Burns and scalds
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TOPICAL SOLUTION, 3 gActive substance: hydrogen peroxideManufacturer: Laboratorio Reig Jofre, S.A.Prescription not requiredDosage form: TOPICAL SOLUTION, 3 g hydrogen peroxide / 100 mlActive substance: hydrogen peroxideManufacturer: Pharmex Advanced Laboratories S.L.Prescription not requiredDosage form: CREAM, 2%Active substance: fusidic acidManufacturer: Isdin S.A.Prescription required
A burn is damage to the skin from dry heat: an iron, a hob, an open flame. A scald is the same injury caused by hot liquid or steam. Only the source differs; the first aid is identical. At home, scalds from hot drinks and tap water are the most common of all, and almost half of the people hurt are children under five. The outcome turns on two things: how quickly the wound was cooled, and how accurately its depth was judged.
First aid: twenty minutes under running water
- Stop the heat. Move the person away from the source, put out flames with water or smother them with heavy fabric; anyone whose clothing is alight should lie down and roll, not run.
- Take off clothing and anything around the burn — rings, bracelets, a watch, a baby's nappy — before the swelling starts. Whatever is stuck to the skin is left alone.
- Cool under cool running water for at least twenty minutes. This is the one action that genuinely reduces how deep the injury goes, and it is still worth starting an hour or two later.
- Keep the rest of the body warm with a blanket, clear of the wound: over a large area, and in children, cooling of the whole body sets in fast and is dangerous in itself.
- Cover the burn with kitchen cling film laid on in loose layers, never wound around: the limb will swell. A clean plastic bag suits a hand; otherwise use lint-free cloth.
- Raise the burnt arm or leg above the level of the heart to limit swelling.
- Treat the pain with paracetamol or ibuprofen. Children and teenagers are not given aspirin.
What not to do
- put on ice or iced water — they narrow the vessels and drive the burn deeper;
- smear on oil, sour cream, toothpaste, spirit or flour: all of it traps heat, obscures the wound and introduces infection;
- burst or trim blisters — their roof is a sterile cover over the wound;
- peel away stuck fabric, melted synthetics or a dried crust;
- lay cotton wool or fluffy material on the wound, where it will stick;
- wrap a tight circular bandage around a limb that is swelling.
How deep the burn goes, and why pain is a poor guide
Skin has three floors: the epidermis, the dermis beneath it and the fatty layer under that. Everything else follows from how far down the damage reached.
- Superficial. Only the epidermis is affected: red, dry, painful skin with no blisters. It heals in a few days without a trace — an ordinary sunburn looks like this.
- Superficial dermal. Pale pink, moist, blistered skin that hurts a great deal. It heals in about two weeks and usually leaves no scar.
- Deep dermal. Blotchy red-and-white skin, dry, with the pain blunted. It heals slowly and with a scar, and often needs surgery.
- Full thickness. White, waxy, brown or charred skin, firm and leathery, with no blisters and no feeling. It will not heal on its own and needs a skin graft.
Hence the rule people forget most often: a painless burn is not a mild one, it is the worst kind. It does not hurt because the nerve endings in the skin have died.
The second trap: in the first hours even an experienced doctor cannot pin down the depth. The wound goes on declaring itself for two or three days and may turn out deeper than it first looked, which is why a serious burn is examined again. Size is estimated against the injured person's own palm with the fingers — roughly one per cent of the body surface.
When hospital is needed
Straight away, to an emergency department or by calling the emergency services:
- a burn larger than the injured person's palm;
- any deep burn — white, charred or numb skin — whatever its size;
- burns to the face, neck, hands, feet, major joints, groin or genitals;
- a burn that runs right around a finger, an arm, a leg or the chest: the rising swelling squeezes the tissues from within and shuts off blood flow and breathing;
- any chemical burn and any electrical burn;
- a burn in a child under five or in an older person;
- a burn in pregnancy, or in someone with diabetes, heart, lung or liver disease, or a weakened immune system;
- signs of shock: cold clammy skin, fast shallow breathing, weakness, confusion;
- any suspicion that the burn was inflicted deliberately.
Later on, see a doctor if the burn has not begun to heal within two weeks, or if signs of infection appear: pain that keeps building, pus, redness spreading outwards, fever.
Chemical, electrical and sun burns
Chemical. Put gloves on first. Brush dry powder off the skin while it is still dry, and only then rinse — copiously, under running water, for far longer than twenty minutes. Take off contaminated clothing. Do not neutralise an acid with an alkali or the other way round: the reaction gives off heat and adds a thermal burn to the chemical one. Bring the product's packaging with you. If the substance has got into an eye, rinse without stopping and call for help at once.
Electrical. On the surface these often look trivial, while the damage runs deep along the path the current took, and muscle can be destroyed under unbroken skin. Current can also throw the heart's rhythm off, so everyone involved needs examination and an electrocardiogram. At household voltage, cut the power first or push the person clear with a dry non-conducting object. Near a power line do not approach at all: the ground around it is dangerous too — wait for the rescue crew.
Sunburn. Shade, a cool shower, plenty to drink, a soothing moisturiser and ordinary pain relief; blisters are left intact. If there are many blisters, or chills, fever, headache or nausea appear, this is no longer simply "caught the sun" and a doctor is needed, especially for a child.
Smoke and hot air: the danger that arrives late
The most treacherous thing about a fire is not what shows on the skin. Breathing hot air and smoke injures the airway, and the swelling there builds over hours: someone who looked fine straight after the event may start struggling for breath by evening.
Warning signs: soot around the mouth and inside the nose, singed eyebrows and nasal hairs, a hoarse voice, a barking cough, wheezing or laboured breathing, a sore throat, sooty sputum, burns on the face.
The products of combustion are a separate danger — carbon monoxide and cyanides. They cause headache, nausea, drowsiness and confusion while the skin stays pink and the pulse oximeter reads normal: a well-known trap. So anyone who has been in a smoke-filled enclosed space should be assessed by a doctor, even with the skin untouched.
While the wound heals
A small burn is kept clean under a non-adherent dressing, changed as the doctor advised. If a blister has burst by itself, the loose skin is not trimmed away but left covering the wound. Itching as it heals is normal and eases with an unperfumed cream.
What parents are rarely warned about. In children, in the first days and even after a small burn, toxic shock syndrome can develop — a violent reaction to bacterial toxins. The signs are high fever, a rash like sunburn, vomiting, diarrhoea, unusual listlessness or confusion. It unfolds over hours and needs immediate help, while the wound itself looks entirely calm.
A scar after a deep burn matures over a year to eighteen months: first it reddens, thickens and itches, then it fades and softens. Throughout that time moisturising, gentle massage and high-factor sun protection all help, because new skin darkens stubbornly under ultraviolet. For extensive scars the doctor selects silicone sheets and pressure garments.
Anxiety, intrusive memories, broken sleep, fear of fire and a hard relationship with one's own appearance after a burn are neither rare nor a weakness. It is worth telling the doctor: help works here.
What children get burnt on most
- hot drinks: a cup of tea is still dangerous to a child a quarter of an hour after it was poured;
- the bath: run the cold water first and the hot afterwards, and test with your elbow; a thermostatic mixer is safer still;
- the kitchen: kettle against the wall with a short flex, pans on the back rings, handles turned inwards;
- irons and hair straighteners stay hot long after they are switched off — put them away at once and high up;
- matches, lighters, candles, open fires and heaters without a guard;
- a bottle warmed in the microwave heats unevenly: shake it and test a drop on your wrist;
- the sun: shade in the middle of the day, loose clothing, a hat and cream; babies under six months are kept out of direct sunlight altogether.
A working smoke alarm and a thought-out way out of the home are worth more than any first aid kit.
Online consultation
At an online appointment the doctor uses photographs and your account to judge whether the burn looks superficial or shows signs of depth, explains what to dress it with and how often, which changes to watch for over the coming days, and when a face-to-face examination is needed. The same visit covers whether tetanus protection is due and how to look after the scar as it matures.
This material is for information only and does not replace medical advice.
Consult with a doctor about Burns and scalds
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Burns and scalds
Discuss your symptoms and possible next steps for Burns and scalds with a doctor online.
