Introduction

An external burn is damage to the skin's tissues. Burns can be very painful and can cause blisters and charred, black or red skin. Burns and scalds can be very painful and can cause blisters to form on the skin.

A scald is a burn that is caused by hot liquid or steam. Scalds are managed in the same way as burns.

A blister is a small pocket of fluid in the upper layers of the skin.

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Shock is a life-threatening condition that occurs when there is an insufficient supply of oxygen to the body.

When to get medical attention

Depending on how serious a burn is, it may be possible to treat it at home. For minor burns, keep the burn clean and do not burst any blisters that form. More serious burns will require professional medical attention. For example, burns that will need medical attention include:

• Large or deep burns
• All chemical and electrical burns
• People who may be at greater risk from the effects of burns, such as children under five years of age and pregnant women, should also seek medical attention after a burn or scald.
• A healthcare professional will assess the size and depth of the burn, clean the affected area and apply a dressing. They will also tell you when the dressing should be changed and offer pain relief, if necessary.
• If you need advice about a burn you should contact your GP or GP out of hour’s service.

What causes burns?

Burns can be caused by:

• Direct contact with something hot, such as fire
• Radiated heat from an external source, such as the sun
• Certain chemicals
• Electricity
• Friction - when an object or surface rubs against something else

Symptoms

The symptoms of a burn or scald will vary depending on how serious it is. You may have some of the following:

• Red skin
• Peeling skin
• Blisters
• Swelling
• White or charred skin
• Pain

The amount of pain that you feel is not always related to how serious the burn is. Some minor burns can be very painful, while some major burns may not hurt at all.

Your skin

Your skin is your body's largest organ. It has many functions, including acting as a barrier between you and the environment and regulating your temperature. Your skin is made up of three layers.

The epidermis (the outer layer of your skin) is 0.5-1.5mm thick. It has five layers of cells that work their way up to the surface of your skin, where dead cells are shed approximately every two weeks.

The dermis (the underlying layer of fibrous tissue) is 0.3-3mm thick and is made up of a mix of three types of tissue. The dermis contains your hair follicles and sweat glands, as well as small blood vessels and nerves.

The subcutaneous fat or subcutis (the final layer of fat and tissue) varies in thickness from person to person. It contains your larger blood vessels and nerves, and regulates the temperature of your skin and body.

Types of burns

Burns are assessed by healthcare professionals based on how seriously your skin is damaged. There are four main types of burns:

• Superficial epidermal (first-degree) burns
• Superficial dermal (second-degree) burns
• Deep dermal or partial thickness (second-degree) burns, and
• Full thickness (third-degree) burns

Superficial epidermal (first-degree) burns are where the epidermis is damaged. Your skin will be red, slightly swollen and painful but not blistered.

Superficial dermal (second-degree) burns are where the epidermis and part of the dermis are damaged. Your skin will be pale pink, painful and there may be small blisters.

Deep dermal or partial thickness (second-degree) burns are where the epidermis and the dermis are damaged. This type of burn makes your skin turn red and blotchy. Your skin may also be dry or moist, become swollen and blistered, and it may be very painful or painless.

Full thickness (third-degree) burns are where all three layers of skin (the epidermis, dermis and subcutis) are damaged. In this type of burn, the skin is often burnt away and the tissue underneath may appear pale or blackened. The remaining skin will be dry and white, brown or black with no blisters. The texture of the skin may also be leathery or waxy.

Treatment

Burns & Scalds

It is essential to apply appropriate first aid to any burn or scald as soon as possible. This will limit the amount of damage to your skin. You may need to apply these first aid techniques to yourself or to another person who has been burnt.

First aid advice for burns and scalds is outlined below.

• Stop the burning process as soon as possible. This may mean removing the person from the area, dousing flames with water or smothering flames with a blanket. Do not put yourself at risk of getting burnt as well.
• Remove any clothing or jewellery near the burnt area of skin, but do not attempt to remove anything that is stuck to the burnt skin because this could cause more damage.
• Cool the burn with cool or lukewarm water for 10-30 minutes, ideally within 20 minutes of the injury occurring. Never use ice, iced water or any creams or greasy substances, such as butter.
• Make sure that the person keeps warm, using a blanket or layers of clothing (avoiding the injured area). This is to prevent hypothermia occurring, when a person's body temperature drops below 35°C (95°F). This is a risk if you are cooling a large burnt area, particularly in children and the elderly.
• Cover the burn with cling film in a layer over the burn, rather than by wrapping it around a limb. A clean, clear plastic bag can be used for burns on your hand.
• The pain from a burn can be treated with paracetamol or ibuprofen. Always check the manufacturer's instructions when using over-the-counter (OTC) medication. Children under 16 years of age should not be given aspirin.
• Once you have taken these steps, you will need to decide whether further medical treatment is necessary.

Electrical burns

Electrical burns may not look serious, but they can be very damaging. Someone who has an electrical burn should seek immediate medical attention at an Emergency Department (ED).

If the person has been injured by a low-voltage source, up to 220-240 volts (such as a domestic electricity supply), safely switch off the power supply or remove the person from the electrical source using a non-conductive material. This is a material that does not conduct electricity, such as a wooden stick or a wooden chair.

Do not approach a person who is connected to a high-voltage source (1,000 volts or more).

Chemical burns

As with electrical burns, chemical burns can be very damaging and immediate medical attention should be sought at an A&E department.

If possible, find out what chemical caused the burn so that you can inform the healthcare professionals when receiving medical assistance.

If you are assisting someone else, wear appropriate protective clothing, then:

• Remove any affected clothing from the person who has been burnt
• If the chemical is in a dry form, brush it off the skin
• Use running water to remove any traces of the chemical from the burnt area

Sunburn

In cases of sunburn, follow the advice below.

• If you notice any signs of sunburn, such as hot, red and painful skin, move into the shade or preferably inside.
• Take a cool bath or shower to cool down the burnt area of skin.
• Apply after-sun lotion to the affected area to moisturise, cool and soothe it. Do not use greasy or oily products.
• If you experience any pain, paracetamol or ibuprofen should help to relieve it. Always read the manufacturer's instructions and do not give aspirin to children under 16 years of age.
• Stay hydrated by drinking plenty of water.
• Watch out for signs of heat exhaustion or heatstroke, when the temperature inside your body rises to 37-40°C (98.6-104°F) or above. These include dizziness, a rapid pulse or vomiting.

Seek medical advice if you experience any of the symptoms of heat exhaustion or heatstroke. See Complications for more information.

Seek medical assistance in the following situations:

• If the burn is deep or large, or if there is blistering (pockets of fluid on the skin)
• If the burn is on the face, hands, feet, genital area, joint areas or is around the upper body, neck or a limb
• If it is an electrical or chemical burn
• If the burn is infected (see Complications)
• If smoke or fumes have been inhaled
• If there are other injuries that need attention
• If the person is going into shock (see Complications)
• If someone has symptoms of heat exhaustion or heatstroke
• If the burn is difficult to manage at home or help is needed with pain control diabetes
• If the person has a pre-existing medical condition, such as heart, lung or liver disease, or (a long-term condition caused by too much glucose in the blood) HIV or AIDS
• If the person has a weakened immune system (the body’s defence system), for example because they have , or they are receiving chemotherapy (a treatment for cancer)
• If the affected person is pregnant
• If the affected person is over 60 years of age or a child who is under five years of age

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