Burns — Types, First Aid, Degrees & Treatment Guide — Symptoms, Causes & Treatment | MyMedicPlus

Burns are injuries caused by thermal, chemical, electrical, or radiation damage to the skin and deeper tissues. They are classified by depth: superficial (1st degree) — affects only the epidermis, causing redness and pain; partial thickness (2nd degree) — involves the dermis, causing blisters and intense pain; full thickness (3rd degree) — destroys all skin layers and nerve endings (painless); and deep tissue/4th degree burns extend to bone. Annually, 11 million burns require medical attention worldwide. Scalds from hot liquids are the most common cause in children; flame burns predominate in adults. Burns injuries represent one of the most devastating forms of trauma, requiring specialised multidisciplinary care in dedicated burns units. The physiological response to major burns (over 20% TBSA) includes the hypermetabolic state — a profound increase in metabolic rate (up to 200% above baseline) requiring intensive nutritional support with 2,000-2,500 kcal/day to prevent muscle wasting, impaired immunity, and delayed wound healing. Modern burns survival rates have improved dramatically — today, 50% total body surface area burns (LD50) in young adults can be survived with optimal care in specialist centres.

Thermal burns (most common): flames, scalds from hot water/cooking, contact with hot objects. Chemical burns: acids and alkalis from domestic cleaners, industrial chemicals, or assault — alkali burns continue to penetrate deeper and may require prolonged irrigation. Electrical burns: household current or high-voltage industrial electricity — entry and exit wounds plus deep internal tissue damage along the current pathway. Radiation burns: sunburn (ultraviolet), ionising radiation from medical/industrial sources. Risk factors: working with open flames or chemicals; young children (scalds) and elderly (impaired reflexes, thinner skin); smoking in bed; limited household smoke alarms. Firework injuries are a significant cause of burns in children, particularly around festivals. Contact burns from hot objects (irons, cooking utensils) are disproportionately common in toddlers who pull items down from surfaces. Non-accidental injury (NAI) should always be considered when burn patterns are inconsistent with the history given — particularly scalds with a glove-and-stocking distribution or cigarette burns in children.

First degree (superficial): redness, pain, dry skin, no blisters — heals in 3-5 days (common sunburn). Second degree (partial thickness): blisters, intense pain, moist/weeping wound surface, pale or red — heals in 7-21 days if not infected. Third degree (full thickness): white, brown, or black leathery skin, painless (nerve destruction), requires skin grafting. Major burns (over 15-20% body surface area in adults, over 10% in children) cause systemic responses: hypovolaemic shock (fluid loss), metabolic stress, infection risk, hypothermia, and inhalation injury (if fire in enclosed space — hoarse voice, stridor, carbonaceous sputum are warning signs). Deep partial thickness burns — affecting reticular dermis but not all skin layers — are pale, blotchy, reduced sensation, and may have fixed staining; they heal in 3-8 weeks with significant scarring risk. Inhalation injury — identified by singed nasal hairs, carbonaceous sputum, hoarse voice, stridor, and facial burns — doubles burns mortality and requires early intubation.

Burn severity assessment uses: Lund and Browder chart or 'Rule of Nines' to estimate total body surface area (TBSA) burned; burn depth classification (clinical examination — appearance, pain, blanche on pressure, sensation); and associated injuries assessment (inhalation injury, electrical injury). Major burns criteria requiring specialist burns unit referral include: over 10% TBSA in adults (over 5% in children or over 60 years); full thickness burns over 5% TBSA; burns to face, hands, feet, genitalia, perineum, or major joints; circumferential burns; chemical or electrical burns; and suspected inhalation injury. Wound biopsy and laser Doppler imaging (LDI) are increasingly used to objectively determine burn depth and healing potential — LDI has 97% accuracy in predicting whether burns will heal within 14 days, guiding decisions between conservative dressings and early surgical grafting. Burns affecting face, hands, genitalia, perineum, or feet require specialist assessment regardless of TBSA percentage due to functional and cosmetic implications.

Immediate first aid: cool the burn with cool (not icy) running water for 20 minutes — even if delayed up to 3 hours, cooling remains beneficial and reduces healing time and pain. Remove clothing and jewellery. Cover loosely with cling film or a clean dressing. Do NOT apply butter, toothpaste, or ice. Minor burns: wound cleaning with mild soap, non-adherent silicone dressings (Mepitel), antibacterial creams (silver sulfadiazine, cerium nitrate) if infection risk. Major burns hospital treatment: intravenous fluid resuscitation (Parkland formula: 4 mL x TBSA% x weight in kg in 24 hours), nutritional support (high protein/calorie), wound care, early excision and split-thickness skin grafting (reduces infection and hospital stay), escharotomy for circumferential burns to release constriction, and management of inhalation injury (humidified oxygen, bronchodilators, mechanical ventilation).

Untreated or inadequately treated burns lead to: wound infection (Pseudomonas, Staphylococcus, Streptococcus — can progress to sepsis and death); contracture (scar tissue causes joint deformity and functional limitation — especially over hands and neck); hypertrophic scarring and keloid formation (permanent disfigurement); compartment syndrome from oedema or circumferential burns; renal failure from myoglobinuria in electrical burns; and inhalation injury causing respiratory failure. Major burns carry mortality rates from 5-50% depending on age, TBSA, and inhalation injury, even with modern treatment. Psychological complications — post-traumatic stress disorder (PTSD) and depression — affect 30-50% of burn survivors and are independent predictors of long-term disability and reduced quality of life, requiring integrated psychological support as part of burns rehabilitation.

Install and maintain smoke detectors on every level of your home and test them monthly. Keep hot water heaters set to 48-49 degrees Celsius or below to prevent scalds. Never leave children unsupervised near cookers, open fires, or hot water. Store chemicals in locked cupboards with child-resistant caps. Wear protective clothing (gloves, aprons, face protection) when handling chemicals or hot substances. Avoid smoking in bed. Practice workplace fire safety and follow protocols for chemical handling. For burn survivors: use compression garments during healing to reduce hypertrophic scarring; apply SPF 50+ sunscreen to healed areas (new skin is sun-sensitive for 12-18 months); and participate in physiotherapy/occupational therapy to maintain joint function and prevent contracture.

Call 999 or attend A&E immediately for: any burn larger than the palm of the hand; burns to the face, hands, feet, genitals, or major joints; circumferential burns around a limb or the chest; electrical burns (even small-appearing contact burns — internal injury may be extensive); chemical burns (continue irrigating with water for 20+ minutes while waiting for emergency services); suspected inhalation injury — hoarse voice, stridor, soot around nose or mouth, burnt nasal hairs; and burns in children under 5 or elderly adults. For apparently minor burns at home: see a GP if blisters are larger than 3 cm, healing has not started within 2 weeks, or if signs of infection develop — increasing redness, swelling, discharge, fever, or a smell from the wound.