Discover causes, symptoms, and treatment options for burns. Learn how to prevent and manage burns for optimal healing and recovery with Meri Sehat's comprehensive guide.

Burns

Overview

A burn refers to damage to the skin or other tissues caused by heat, radiation, electricity, chemicals, or friction. 
Burns are one of the most frequent injuries, especially at home for kids. The word &quot;burn&quot; refers to more than just the burning sensation this injury causes. Burns are characterized by significant skin injury that results in the death of the impacted skin cells, causing either minor medical issues or serious medical emergencies. 
&nbsp;

The location and extent of the damage determine the treatment. Most sunburns and minor burns can be treated at home. However, burns that are severe or widespread require rapid medical intervention; some patients are transferred to specialized burn facilities and then need follow-up care for several months.

Burns cause nearly 180,000 fatalities annually, with the majority taking place in low- and middle-income nations<a href="#accordion">[1]</a>. 17% of burnt children in Bangladesh, Colombia, Egypt, and Pakistan have a temporary disability, while 18% have a permanent one<a href="#accordion">[1]</a>.

While burn fatality rates have been falling in many high-income nations, yet 500,000 Americans approximately still seek medical attention for unintentional burns every year<a href="#accordion">[2]</a>. 
&nbsp;

Depending on how severely the skin has been damaged, doctors divide burns into various categories or &quot;degrees.&quot; Currently, there are four different degrees of burns: first, second, third, and fourth. The severity of the burn increases with the degree: 
&nbsp;

<ol>
	<li>&nbsp;First Degree: The only part of the skin that is burned is the epidermis. A minor sunburn is one example. There won&#39;t be any blisters, but the skin will turn red and sore. Long-term harm is uncommon in a first-degree burn. 
	&nbsp;</li>
	<li>&nbsp;Second Degree: The skin&#39;s dermis, the layer beneath the epidermis, is also affected. The skin appears bright&nbsp;red and swollen. Blisters may appear and the affected area will be uncomfortable to touch:</li>
</ol>

<ul>
	<li>If the burn is superficial, only some part of the dermis gets damaged. There will probably be no scarring.</li>
	<li>If the burn is deep or even partially affecting the dermis, it will be more severe. It can cause a scar or leave a permanent skin color change. 
	&nbsp;</li>
</ul>

<ol start="3">
	<li>&nbsp;Third Degree: This kind of injury, often known as a &quot;full thickness burn,&quot; affects two complete layers of the skin. The burned skin presents as black, brown, white, or yellow instead of turning red. This kind of burn also affects nerve endings; therefore, it won&#39;t hurt. 
	&nbsp;</li>
	<li>&nbsp;Fourth Degree: This is the most severe and deepest type of burn and is considered a life hazard. It destroys bones, muscles, and tendons along with all the layers of the skin. 
	&nbsp;</li>
</ol>

Signs and Symptoms

Depending on the degree or severity of the burn, several symptoms may be present at any given time. The symptoms are usually the worst during the initial hours or days following a burn. They include: 
&nbsp;

<ul>
	<li>Redness or discoloration of the skin</li>
	<li>Pain or discomfort</li>
	<li>Swelling or blistering of the skin</li>
	<li>Peeling or flaking of the skin</li>
	<li>Itching or a tingling sensation</li>
	<li>Scarring or permanent disfigurement</li>
	<li>Shock, which presents as rapid heartbeat, shallow breathing, and pale skin</li>
	<li>Difficulty breathing or wheezing</li>
	<li>Nausea or vomiting</li>
	<li>Fainting or loss of consciousness 
	&nbsp;</li>
</ul>

An airway burn can have the following signs and symptoms:

<ul>
	<li>Coughing</li>
	<li>Burned head, neck, and face, including eyebrows and nose hair&nbsp;</li>
	<li>Burned mouth and lips</li>
	<li>Difficulty breathing or wheezing</li>
	<li>Dark, black-stained mucus</li>
	<li>Change in voice 
	&nbsp;</li>
</ul>

Causes

The most common cause of burns in people is open flames. Other causes include: 
&nbsp;

<ul>
	<li>Cold Burns&nbsp;- Cold burns, often known as &quot;frostbite,&quot; harm the skin by freezing it. Spending time outside in subfreezing conditions can cause frostbite. It can also occur if the skin is near something extremely cold for an extended amount of time, like a cold pack used to treat an injury can cause ice burn if it&rsquo;s directly pressed against the bare skin for a long time. 
	&nbsp;</li>
	<li>Friction Burns - A friction burn occurs when the skin is partially removed by a harsh item. It&#39;s a heat burn as well as an abrasion. Accidents involving motorcycles and bikes can lead to this type of burn. Another form of friction burn is carpet burn. 
	&nbsp;</li>
	<li>Thermal Burns - When a person touches a burning item, their skin becomes so hot that the skin cells begin to die. Thermal burns are brought on by hot metals, scorching liquids, steam,&nbsp;and flames. 
	&nbsp;</li>
	<li>Radiation Burns&nbsp;- These can be brought on by radiation sources, such as X-rays or radiation treatment used to treat cancer. Sunburn is another form of radiation burn. 
	&nbsp;</li>
	<li>Chemical Burns - Solvents, strong acids, or detergents cause the skin to burn. 
	&nbsp;</li>
	<li>Electrical Burns&nbsp;- This type of burn happens when the person comes in contact with an electrical current. 
	&nbsp;</li>
</ul>

Burns mostly happen at home and work. According to research conducted in Bangladesh and Ethiopia, 80&ndash;90% of burn injuries take place at home. Children and women typically sustain burn injuries in kitchens from cookstove explosions or upset containers holding hot liquids. At the workplace, burns from fire, scalds, chemicals, and electricity most frequently affect men<a href="#accordion">[1]</a>. 
&nbsp;

Diagnosis

A doctor will assess the degree or severity of the burn by calculating the depth and percentage of the burn that has impacted the body. The burns will then be classified as: 
&nbsp;

<ul>
	<li>Minor&nbsp;- Minor burns do not often require hospitalization. First and second-degree burns covering less than 10% of the body are said to be minor. 
	&nbsp;</li>
	<li>Moderate&nbsp;- Moderate burns are&nbsp;second-degree burns&nbsp;that cover 10% or less of the body. Burns that affect the hands, feet, face, or genitalia can be moderate to severe. 
	&nbsp;</li>
	<li>Severe&nbsp;- Severe burns are&nbsp;third-degree burns&nbsp;that cover more than 1% of the body. 
	&nbsp;</li>
</ul>

Depending on the severity of the burns, the healthcare professional decides if the patient needs to be transferred to a burn center. 
&nbsp;

Treatment

<h5>Treatment For Minor Burns</h5>

<ul>
	<li>Cool Down The Burn&nbsp;- For about 10 minutes, place the affected region under cool (not cold) flowing water. If the face is the affected area apply a cool, moist cloth to the burned area of the face until the pain subsides. Put a piece of ice in the mouth for a few minutes in case of a mouth burn from hot food or drink. 
	&nbsp;</li>
	<li>Remove Tight Items From The Burned Area&nbsp;- Remove rings and other tight items as soon as possible before the area starts to swell up. 
	&nbsp;</li>
	<li>Do Not Pop The Blisters - Blisters protect the wound from infection. If the blister pops on its own, do not remove the skin. Gently clean the area using water and apply antibiotic ointment. 
	&nbsp;</li>
	<li>Apply Lotion&nbsp;- After the affected area has cooled down, it&rsquo;s important to apply some lotion so that the wound does not dry out. Additionally, if the lotion has cocoa butter or aloe vera, it could be more beneficial. 
	&nbsp;</li>
	<li>Cover The Burn&nbsp;- Use a clean bandage to loosely cover the burn. Avoid bandaging the skin tightly as it puts unnecessary pressure on the wound. The bandage is to protect the skin from air, protects the blistered skin, and reduces pain. 
	&nbsp;</li>
	<li>Pain Killers&nbsp;- An over-the-counter painkiller, such as ibuprofen, naproxen sodium, or acetaminophen, can be used to relieve pain. 
	&nbsp;</li>
</ul>

<h5>Treatment For Major Burns</h5>

NOTE: Major burns will require emergency medical attention. The following tips should only be considered until the help arrives. 
&nbsp;

<ul>
	<li>Stop Further Harm&nbsp;- Make sure the patient is no longer in contact with the burn&#39;s source to ensure their safety. If they&rsquo;re on fire, tell them to stop, drop, and roll. If it&rsquo;s an electrical burn, cut off the power source before approaching them. Do NOT attempt to take the clothing off that is stuck to the burned area. 
	&nbsp;</li>
	<li>Ensure That The Person Is Breathing&nbsp;- Begin rescue breathing or CPR at this stage. 
	&nbsp;</li>
	<li>Remove Belts, Jewelry, Or Any Tight Items&nbsp;- Burned areas swell quickly so it is important to remove tight items immediately. 
	&nbsp;</li>
	<li>Cover The Burn&nbsp;- Loosely cover the burned area. 
	&nbsp;</li>
	<li>Look Out For Signs Of Shock&nbsp;- If the patient doesn&rsquo;t exhibit cool, clammy skin, shallow breathing, and weak pulse, it means their body has not gone into shock yet. If the person does not have a neck, back, head, or leg injury, the following steps can help prevent shock:</li>
</ul>

<ol>
	<li>Lay the person flat</li>
	<li>Raise their feet about 12 inches</li>
	<li>Use a blanket or coat to cover the person</li>
	<li>Keep monitoring the person&rsquo;s breathing rate, pulse, and blood pressure until help arrives 
	&nbsp;</li>
</ol>

Once the patient has reached a health care professional, they will provide the following treatment:

<ul>
	<li>Airway and breathing support that includes a face mask, insertion of a tube into the trachea through the mouth, or a ventilator to support breathing in severe burns involving the airway</li>
	<li>Urine and blood tests if complications, such as shock, occur</li>
	<li>Chest x-ray for airway or face burns</li>
	<li>ECG to monitor the heart in case of complications, such as shock</li>
	<li>IV fluids in case of complications, such as shock, to prevent dehydration and organ failure</li>
	<li>Medication, including anti-anxiety, to relieve pain and distress, and also to prevent infection</li>
	<li>Creams or ointments applied to the burned area</li>
	<li>Special wound dressings to help the wound heal; the health care team will only use dry gauze to cover the wound while the patient is transported to a burn center</li>
	<li>Tetanus immunization is carried out if the patient is not up to date with it</li>
	<li>A feeding tube may be needed for people with extensive burns who need nutritional support 
	&nbsp;</li>
</ul>

<h5>Surgery</h5>

<ul>
	<li>Skin Grafts&nbsp;- During a skin graft, portions of the person&rsquo;s own healthy skin are utilized to repair the scar tissue left behind by severe burns. As a temporary fix, donor skin from people who have passed away is also used at times.<a href="#accordion">[6]</a> 
	&nbsp;</li>
	<li>Plastic Surgery - Burn scars can look better and joints damaged by scarring can become more flexible after plastic surgery. 
	&nbsp;</li>
</ul>

<h5>When To Seek Emergency Medical Attention?</h5>

Call the local emergency number for major burns that:<a href="#accordion">[5]</a>

<ul>
	<li>Involve all layers of the skin</li>
	<li>Cause leathery or dry skin</li>
	<li>Appear charred or have black, brown, or white patches</li>
	<li>Cover more than 3 inches of area</li>
	<li>Are on the face, feet, hands, buttocks, major joints, or around a leg or arm</li>
	<li>Also involve smoke inhalation</li>
	<li>Swell up fast 
	&nbsp;</li>
</ul>

Emergency medical attention is required for severe chemical burns as well as electrical burns, particularly lightning-related injuries.

If a minor burn results in damage to the eyes, mouth, hands, or genital regions, emergency care may be required. Also, minor burns may necessitate emergency treatment in children and elderly people. 
&nbsp;

In case of a minor burn, the patient would require medical attention if they experience<a href="#accordion">[4]</a>:

<ul>
	<li>Pain even after 48 hours</li>
	<li>Pus or fluid from the affected area</li>
	<li>Fever</li>
	<li>Increased pain</li>
	<li>Swollen lymph nodes</li>
	<li>Red streaks spreading from the burn 
	&nbsp;</li>
</ul>

NOTE&nbsp;

Avoid doing the following:<a href="#accordion">[4]</a>

<ul>
	<li>DO NOT use butter, oil, ice, cream, medication, oil spray, or any other remedy on a severe burn.</li>
	<li>DO NOT blow, breathe or cough on the burned area.</li>
	<li>DO NOT pick at dead or blistered skin.</li>
	<li>DO NOT pull on any clothing that is stuck to the burned area.</li>
	<li>DO NOT provide the burn victim with anything by mouth.</li>
	<li>DO NOT use cold water on a severe burn as this can cause shock.</li>
	<li>DO NOT place anything under the person&rsquo;s head to elevate the head, especially in case of an airway burn as it could close up the airway. 
	&nbsp;</li>
</ul>

Third degree burns, which are severe and cover a big area of skin, are extremely dangerous and even fatal. Second-degree burns, too, have the potential to develop into infections and leave scars. 
&nbsp;

Other complications of third-degree burns include:

<ul>
	<li>Dehydration</li>
	<li>Arrhythmia</li>
	<li>Contractures or disfiguring scars</li>
	<li><a href="https://merisehat.pk/disease/pulmonary-edema">Edema</a></li>
	<li>Organ failure</li>
	<li><a href="https://merisehat.pk/disease/pneumonia">Pneumonia</a></li>
	<li>Low blood pressure</li>
	<li>Infection that can lead to amputation or sepsis</li>
	<li>Blood loss leading to hypovolemia and hypothermia</li>
	<li>Post-traumatic stress disorder and <a href="https://merisehat.pk/disease/depression">depression</a> 
	&nbsp;</li>
</ul>

Another potential issue with burns of any kind&nbsp;is tetanus. Tetanus is a bacterial infection. It has an impact on the neurological system, which eventually causes issues with muscular contractions. As a general rule, every individual should get a tetanus injection every 10 years to avoid this kind of infection<a href="#accordion">[7]</a>. 
&nbsp;

The following are the risk factors for getting a burn: 
&nbsp;

<ul>
	<li>Gender&nbsp;- Females are more at risk than men of getting burned in a domestic setting, while the opposite is true for a workplace setting. 
	&nbsp;</li>
	<li>Age&nbsp;- Children, along with adult women, are prone to burns. While inadequate adult supervision is a significant risk, child abuse is also a significant contributor to burn injuries in children. 
	&nbsp;</li>
	<li>Socioeconomic Factors&nbsp;- Burn risk is correlated with socioeconomic position across all nations. 
	&nbsp;</li>
	<li>Other Risk Factors - Any occupation that involves the use of fire, poverty, people with underlying medical conditions (e.g., epilepsy, peripheral neuropathy, physical and cognitive disabilities), alcohol abuse, and smoking are also risk factors<a href="#accordion">[1]</a>. 
	&nbsp;</li>
</ul>

To prevent burns: 
&nbsp;

<ul>
	<li>Install smoke alarms in the house and keep a check on the batteries</li>
	<li>Educate children about the danger of fireworks and matches</li>
	<li>Keep the pot handles facing towards the back of the stove so they cannot be knocked over</li>
	<li>Install fire extinguishers at home, school, and work</li>
	<li>Keep the water heaters&rsquo; temperatures under 120&deg;F (48.9&deg;C)</li>
	<li>Discard electrical cords that have exposed wires</li>
	<li>Make sure all smoking products are stubbed out entirely</li>
	<li>Clean dryer lint traps frequently</li>
	<li>Do not smoke in bed</li>
	<li>Keep electrical outlets covered</li>
	<li>Keep chemicals, lighters, and matches locked up</li>
	<li>Wear sunscreen</li>
	<li>Wear gloves while using chemicals 
	&nbsp;</li>
</ul>

Whether it&rsquo;s home or workplace, there should always be a fire escape plan and all individuals should practice it once a month. 
&nbsp;

NOTE: Make sure to crawl under the smoke if there is a fire. By doing this, the chance of passing out and getting trapped in a fire is reduced. 
&nbsp;

A study reviewed individual participant data (1970-2019) of patients who suffered from burn injuries and developed necrotizing skin and soft tissue infections (NSTI). The study aimed to determine the factors associated with mortality by comparing characteristics and management between patients who survived and patients who died.

The study found that patients with mortality had a greater %TBSA (Total Body Surface Area) burned, more intubations, fewer debridements, fewer skin excisions, more complications, sought treatment and management at a burn center, underwent fewer flap surgeries, less graft survival, and less healed wounds compared to patients with non-mortality. 
&nbsp;

The study also found that non-mortality patients had more debridements, skin excision, systemic antimicrobials, skin graft survival, flaps, improvement following surgery, and healed wounds compared to mortality patients<a href="#accordion">[8]</a>. 
&nbsp;

Key Points

<ul>
	<li>A burn refers to damage to the skin or other tissues caused by heat, radiation, electricity, chemicals, or friction.</li>
	<li>Depending on how severely the skin has been damaged, doctors divide burns into various categories or &quot;degrees.&quot; Currently, there are four different degrees of burns.</li>
	<li>Make sure the patient is no longer in contact with the burn&#39;s source to ensure their safety. If they&rsquo;re on fire, tell them to stop, drop, and roll. If it&rsquo;s an electrical burn, cut off the power source before approaching them.</li>
	<li>The healthcare professional will decide if the patient needs to be transferred to a burn center depending on the severity of the burns.</li>
	<li>During a skin graft, portions of the person&rsquo;s own healthy skin are utilized to repair the scar tissue left behind by severe burns.</li>
	<li>As a temporary fix, donor skin from people who have passed away is also used at times. 
	&nbsp;</li>
</ul>

[1] Burns. World Health Organization

[2] Burns: Types, symptoms & treatment. Cleveland Clinic.

[3] What are the types and degrees of Burns? WebMD

[4] Pennmedicine.org.

[5] First Aid for burns. Mayo Clinic.

[6] Burns. Mayo Clinic

[7] Kahn A. Burns: Types, symptoms, and treatments

[8] Klifto KM, Gurno CF, Seal SM, Hultman CS. Factors Associated With Mortality Following Burns Complicated by Necrotizing Skin and Soft Tissue Infections: A Systematic Review and Meta-Analysis of Individual Participant Data. J Burn Care Res. 2022;43(1):163-188. doi:10.1093/jbcr/irab045