Burns — Causes, Symptoms & Treatment Guide — Symptoms, Causes & Treatment | MyMedicPlus

Burns are tissue injuries caused by heat, chemicals, electricity, radiation, or friction. They represent a major global health problem — approximately 11 million people require medical attention for burns annually, with approximately 180,000 deaths per year, predominantly in low- and middle-income countries. Burns are classified by cause (thermal — flame, scalds, contact; chemical — acid, alkali; electrical — low and high voltage; radiation — sunburn, radiotherapy) and by depth: superficial (epidermal only — redness, pain, no blistering), superficial partial-thickness (epidermis and superficial dermis — blisters, moist, painful), deep partial-thickness (epidermis and deep dermis — reduced sensation, mottled appearance), and full-thickness (all layers — white/brown/charred, no pain due to nerve destruction). Total body surface area (TBSA) involved guides fluid resuscitation — estimated using the Wallace Rule of Nines or the Lund-Browder chart (more accurate in children). Major burns (10% TBSA or above in children, 15-20% or above in adults) are life-threatening emergencies.

Scalds (hot liquids, steam) are the most common cause of burns overall — particularly in children under 5, who are disproportionately affected (pulling hot beverages, bath scalds). Flame burns (from domestic fires, cooking, BBQs) are the most common cause of adult burns. Chemical burns: acids cause coagulative necrosis (self-limiting penetration); alkalis cause liquefactive necrosis (more penetrating and progressive — cement, oven cleaners, sodium hydroxide). Electrical burns: low-voltage (240V household current — can cause cardiac arrhythmia from current passing through the chest); high-voltage (industrial, lightning — extensive deep tissue injury with entry and exit wounds). Radiation burns: sun exposure (UV radiation causing sunburn) and therapeutic radiation (radiotherapy). Friction burns: road rash from motorcycle accidents. Risk factors: age under 5 (mobility, curiosity, thin skin) and over 65 (impaired sensation, slower reaction, comorbidities); occupational exposure; alcohol or drug intoxication; epilepsy; physical disability; and male sex (higher occupational and recreational burn risk).

Superficial (epidermal) burns: erythema (redness), pain, and warmth without blisters — sunburn is the classic example. Heals in 5-7 days without scarring. Superficial partial-thickness burns: blistering, moist, pink or red wound surface, exquisitely painful (intact nerve endings), blanches with pressure. Heals in 14-21 days, usually without significant scarring. Deep partial-thickness burns: patchy red/pale/white appearance, decreased pain sensation (due to nerve involvement), does not blanche reliably, moist or dry. Requires 3-6 weeks to heal with significant scarring; often requires surgical intervention. Full-thickness burns: dry, leathery, white-brown-black appearance, loss of pain sensation (complete nerve destruction), no blanching, fixed non-mobile eschar. Will not heal spontaneously over large areas — requires skin grafting. Inhalation injury (smoke inhalation): hoarseness, stridor, carbonaceous sputum, eyebrow/facial hair singeing, altered consciousness — a life-threatening emergency; always suspect in burns in enclosed spaces.

Burns assessment includes: burn depth characterisation (clinical assessment — depth assessment is frequently inaccurate in the first 48-72 hours as deep burns may initially appear superficial); TBSA calculation using the Rule of Nines (head and each arm 9%, each leg 18%, front/back torso 18%, perineum 1%) or Lund-Browder chart for children (accounts for different proportions); assessment for inhalation injury (laryngoscopy or fibreoptic bronchoscopy for suspected airway burns); and circumferential burn assessment (requires escharotomy if affecting chest or limbs — restricts breathing or circulation). Blood tests for major burns: FBC, U+E, clotting, ABG, carboxyhaemoglobin (CO poisoning from smoke), CK (rhabdomyolysis from electrical burns). ECG for electrical burns. Urine output monitoring (aim 0.5-1 mL/kg/hour) is a key indicator of adequate fluid resuscitation. Wound swabs for infection monitoring in hospital. Referral criteria to specialist burns unit (UK National Burn Care Referral Guidelines): any burn in a child, burns over 5% TBSA in adults, full-thickness burns, burns to face/hands/feet/genitalia/joints, chemical or electrical burns, inhalation injury, and circumferential burns.

Immediate first aid — cooling: cool the burn under cool running water (not cold or iced — vasoconstriction worsens injury) for 20 minutes, starting within 3 hours of injury (ideally within 30 minutes); remove clothing and jewellery from burned areas (not if stuck to the skin); cover with cling film (not cotton wool — fibres adhere) loosely. Do not apply butter, toothpaste, ice, or egg — these are harmful. ABC assessment: airway (most critical — early intubation for inhalation injury before oedema obstructs airway), breathing, circulation. High-flow oxygen for all burns in enclosed spaces (CO poisoning). IV fluid resuscitation for burns of 15% TBSA or above in adults, 10% or above in children: Parkland formula — 4 mL of Hartmann's solution per kg body weight per % TBSA burned, half given in the first 8 hours, remainder over 16 hours. Wound management: superficial burns — emollient moisturiser; partial-thickness burns — moist wound dressings (Mepitel, Mepilex Ag — antimicrobial silver dressings, changed every 3-5 days); full-thickness burns — surgical debridement and skin grafting under general anaesthesia (autograft — split-thickness skin graft from unburned donor site; allograft/artificial skin substitutes for large burns). Escharotomy (longitudinal incisions through the eschar) for circumferential full-thickness burns causing compartment syndrome of limbs or chest. Analgesia: opioids (morphine, fentanyl) for acute pain; ketamine for dressing changes. Nutritional support: early nasogastric feeding for major burns — hypermetabolic state increases caloric requirements 2-3x. Infection prevention: no prophylactic antibiotics — treat infection when identified. Physiotherapy from day 1 to prevent joint contracture and scar formation.

Major burns carry a high risk of serious complications across all organ systems. Infection and sepsis: loss of the skin barrier makes burn wounds highly susceptible to infection with Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter, and invasive fungi — burn wound sepsis is the leading cause of death in patients surviving initial resuscitation. Inhalation injury with acute respiratory failure and ARDS occurs in burns from enclosed spaces — ARDS mortality in burn patients reaches 40-50%. Hypovolaemic shock from massive fluid loss through damaged skin and third-spacing causes acute kidney injury and multi-organ failure if resuscitation is inadequate. Compartment syndrome develops in circumferential burns as tissue oedema within the rigid eschar constricts blood flow — requiring immediate escharotomy to prevent ischaemia and gangrene. Hypothermia: loss of thermoregulatory skin function compounds coagulopathy in major burns. Carbon monoxide poisoning from smoke inhalation causes tissue hypoxia and can produce permanent neurological injury or death. Long-term complications: hypertrophic scars and keloid formation cause cosmetic disfigurement, joint contractures restricting movement, chronic neuropathic pain, and pruritus. Psychological consequences including PTSD, depression, and body image disturbance affect up to 40% of major burns survivors, requiring specialist psychological rehabilitation.

Home fire safety: install smoke alarms on every level and test monthly; have a fire escape plan; never leave cooking unattended; keep hot liquids away from children; set water heater to 48-50°C (120-122°F) to prevent scald burns; use fire guards in front of fireplaces. Child safety: supervise young children near hot liquids, cookers, ovens, and radiators; use coiled oven hob guards; place hot drinks in the centre of tables away from edges; never hold a child while carrying hot liquids. Chemical safety: store all chemical substances in original labelled containers; wear protective gloves when using cleaning agents; eye protection for industrial chemicals. Electrical safety: cover unused electrical sockets; replace damaged extension leads; do not overload sockets. Sunburn prevention: apply broad-spectrum SPF 30 or above sunscreen 20 minutes before sun exposure; reapply every 2 hours; seek shade between 11am-3pm; use sun-protective clothing and wide-brimmed hats. Workplace burns prevention: PPE (heat-resistant gloves, face shields), training, and adherence to safety protocols.

Call 999/112/911 immediately for: large burns (15% TBSA or above in adults, 10% or above in children), any burns to the face, hands, feet, genitalia, or major joints, circumferential burns, chemical or electrical burns, burns with suspected inhalation injury (stridor, hoarseness, carbonaceous sputum), smoke inhalation in enclosed spaces, and burns in children or vulnerable adults. Go to an emergency department for: any burn suspected to be full-thickness, burns blistering larger than 1% TBSA (palm-of-hand sized), burns not responding to first aid or appearing infected (increasing redness, swelling, purulent discharge, fever). See a GP or practice nurse for: small superficial scalds or burns, sunburn with blistering that is not healing, wound check and dressing changes. Do not attempt to treat burns larger than the patient's palm at home.