Overview
A burn is damage to the skin and the tissue under it. Scalds, the commonest kind at home, come from hot liquids and steam: tea, boiling water, hot dal, hot oil. Burns also come from flames and hot metal, from chemicals, from electricity and from the sun.
Burns are described by how deep they go. A superficial burn affects only the top layer and is red, painful and swollen. A partial thickness burn goes deeper and blisters. A full thickness burn destroys the whole thickness of the skin and looks white, brown or leathery, and may not hurt at all because the nerve endings are gone.
Symptoms
- Redness, pain and swelling in a shallow burn
- Blisters, intact or burst, in a deeper burn
- White, brown, black or leathery skin, often with little or no pain, in the deepest burns
- Peeling skin as a burn heals
- Signs that smoke or hot air has been breathed in: a hoarse voice, coughing, soot around the nose or mouth, black-stained spit, difficulty breathing
- Signs of shock after a large burn: cold, clammy, pale skin, fast shallow breathing, drowsiness or fainting
When to see a doctor
See a doctor within a few days if a burn is not healing after about two weeks, if a blister bursts, or if pain, redness, swelling, pus, smell or fever suggest infection.
Causes
Most burns at home are scalds from hot drinks, cooking pots and hot oil, or contact burns from stoves, pressure cookers, irons and hot vessels. Open fires, kerosene stoves and lamps, gas leaks and festival crackers cause the more severe ones.
Burns also come from acids and cleaning chemicals, from electric wiring and appliances, and from long exposure to the sun.
Risk factors
- Children under five, who reach up and pull hot vessels over
- Cooking at floor level, on open fires or on unsafe stoves
- Loose clothing such as a saree or dupatta near a flame
- Kerosene and other liquid fuels stored in the home
- Crowded kitchens and rooms with no separate cooking space
- Epilepsy, reduced sensation in the hands or feet, and conditions that affect balance or judgement
- Work with hot metal, chemicals or electricity without protective equipment
Complications
Burnt skin no longer keeps out germs or holds in fluid, so infection and fluid loss are the main early dangers, and a large burn can cause shock. Smoke breathed in can swell the airway and make breathing difficult hours after the fire.
As deep burns heal they form scars, which can tighten and limit how a joint moves. Burns are also frightening, and people often need help with sleep, anxiety and confidence afterwards.
Prevention
- Cook at a raised surface where possible, and keep children out of the kitchen
- Turn pot handles inward and keep hot drinks away from table edges
- Tie back loose clothing and a dupatta before lighting a stove
- Check bath water with an elbow before putting a child in
- Store kerosene, acid and cleaning chemicals in labelled containers, out of reach and away from the cooking area
- Keep matches, lighters and crackers away from children, and supervise all use of fireworks
- Have wiring and appliances repaired properly, and switch off at the socket before touching them
Diagnosis
A doctor works out how deep the burn is and how much of the body surface it covers, and checks the airway and breathing if there was smoke or a blast. The cause matters too, because chemical and electrical burns behave differently from scalds.
Blood tests and an may be needed after a large burn or an electrical injury, and tetanus cover is checked.
Treatment
First aid, straight away:
- Stop the burning: move away from the heat, put out flames, and flush a chemical off with plenty of running water
- Hold the burn under cool running water for about twenty minutes
- While cooling, remove clothing and jewellery near the burn, leaving anything stuck to the skin in place
- Then cover loosely with cling film laid over the burn, or a clean cloth, and keep the person warm
- Paracetamol can be used for pain
In hospital, the burn is cleaned and dressed, pain relief and fluids into a vein are given for larger burns, and are used if it becomes infected. Deep or extensive burns may need surgery to remove dead tissue and a skin graft, followed by dressings, pressure garments and physiotherapy to keep joints moving.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Put toothpaste, ink or haldi paste on a burn.”What is true?
Fact
None of these treats a burn. Guidance from the World Health Organization and from NHS and MedlinePlus first aid is to apply no paste, ointment, cream or household remedy before the burn has been assessed. They trap heat, can cause infection, and have to be cleaned off painfully in hospital.
Myth“Oil, butter or ghee soothes the skin and stops blistering.”What is true?
Fact
Fats hold heat against the skin, so the burn keeps deepening after the accident. Cool running water for about twenty minutes is what actually takes the heat out.
Myth“Ice or an ice pack cools a burn faster than water.”What is true?
Fact
Ice is specifically advised against. It can injure skin that is already damaged and reduce the blood supply to it. Use cool, not freezing, running water, and keep it running for the full twenty minutes.
Myth“Burst the blisters so the burn dries and heals faster.”What is true?
Fact
The blister is a sterile cover that protects the raw skin underneath. Bursting it opens a way in for infection. Leave blisters alone, cover the area loosely, and let a doctor or nurse decide if anything needs to be done.
Myth“If it does not hurt much, the burn is not serious.”What is true?
Fact
How much a burn hurts is not a guide to how deep it is. The deepest burns destroy the nerve endings in the skin, so they can look white, brown or leathery and feel numb. A painless burn needs to be seen, not ignored.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How long should the water run, and what if twenty minutes have already passed?
About twenty minutes of cool running water is the advice, and it is worth starting even up to three hours after the injury. Do not use ice or iced water. If a tap is not available, pour clean water steadily from a jug or bottle.
Is cling film really safe to put on a burn?
Yes, after cooling. Lay it over the burn in a sheet rather than wrapping it round the limb, because the area may swell. It keeps the burn clean, reduces pain and lets a doctor see the wound without disturbing it. A clean cloth or sheet works when cling film is not at hand.
What should be done for a chemical burn?
Take off contaminated clothing without letting the chemical touch anyone else, and rinse the skin with plenty of running water for a long time. Do not try to neutralise an acid with an alkali or the other way round. Take the container or label to hospital, and go straight there.
A child has an electrical burn but seems fine. Do we still go?
Yes. Electricity can injure tissue deep under a small skin mark and can upset the heart rhythm, so what is visible does not show how serious it is. Switch off the power first, do not touch the person until it is off, and take them to hospital for assessment.