Burns

A burn is damage to the skin, and sometimes the soft tissue, muscle and bone under the skin, from contact with heat, chemicals or electricity. The longer the contact with the skin, the worse a burn may be.

Burns can be divided into several types:

• Thermal burns. These are caused by contact with flames, hot liquids, hot surfaces and other sources of high heat or contact with electricity (which generates heat).

• Chemical burns. These types of burns are cause by direct action of acids, bases or other corrosive chemicals on tissue.  They are usually not thermal in nature.

• Radiation burns. These types of burns are caused by free radicals created by radiation or the direct action of energy waves or particles on DNA. The most commonly seen and recognized radiation burn is sunburn, which is caused by ultraviolet light. Radiation burns from X-ray, gamma ray and particle radiation are seldom seen, except in patients undergoing radiation therapy.

Children and older adults are more susceptible to severe burns that occur at lower temperatures because they have thinner skin. A child or older adult whose skin is exposed to 140-degree water for just three seconds can develop a third-degree burn, serious enough to require hospitalization. The higher the temperature, the less time passes before a serious burn develops.

Doctors grade burns as being first, second or third degree. The higher the number, the more serious the damage to the skin's layers.

First-Degree Burns

First-degree burns affect only the top, or first, layer of skin. The skin can be painful to touch, red, dry or slightly swollen. These burns may peel and are usually painful. A mild sunburn or a slight scalding usually results in a first-degree burn. You don't need to see a doctor for a first-degree burn unless a large area of skin is damaged. First-degree burns usually heal in five to six days without leaving scars. If a first-degree burn covers a large area of the body, or the victim is an infant or elderly, seek emergency medical attention.

Second-Degree Burns

Second-degree burns affect the two top layers of skin. Symptoms include deep redness, swelling and blisters. Second-degree burns are painful, and the pain may be severe. Second-degree burns may become infected. Healing takes three to four weeks and may leave scars. Second-degree burns can be fatal if more than half the body is damaged. You can treat most second-degree burns at home if only a small amount of skin is burned. But you should see the doctor if the burn covers more than 1 square inch of skin; the burn causes a lot of blistering; or the burn is on the hand, face or groin.

Third-Degree Burns

Third-degree burns damage all three layers of skin. They may even permanently damage tissue, muscle, nerves, bones or fat underneath the skin. With a third-degree burn, skin may be red, white, waxy or charred black. These burns can be very painful or, if the nerves are destroyed, painless. The burned area may "weep," or ooze large amounts of clear liquid. You must see a doctor right away for all third-degree burns. Treatment by a burn specialist and skin grafts are needed for third-degree burns. There is permanent scarring from a third-degree burn.

Self-Care Steps for Minor Burns

• For small first- or second-degree burns, soak them in cool water or apply cold, wet compresses. Do not use ice water or snow, unless that is the only source of cold available, because either of these could increase the injury by causing hypothermia. The wet, cooling action helps stop any more burning below the skin.

• Cover the entire burn area with a clean, dry, preferably sterile nonstick dressing or cloth that will not leave lint to stick to skin. You can use an over-the-counter product with aloe vera in it to help ease pain. Don't put butter or any other greasy substance on the burn. Don't break blisters that form on the burn.

• Call your doctor if you see any signs of infection on the burned area. Infants, elderly adults and people with diabetes, kidney disease or other chronic conditions may be at more risk for infection.

• Burned skin can itch for weeks and is sensitive to the sun for up to a year after it has healed. Remember to use sunscreen to prevent further damage.

• Check to see whether a tetanus shot is needed.

Self-Care Steps for Severe Burns

• If a person's clothes are on fire, put out the fire with a blanket, towel, rug or coat. Wrap it over the flames. Press down to keep air from reaching the fire. The person may struggle or try to run. Make the person lie still on the floor.

• Pull away bits of clothing that may be smoldering. Leave alone cloth that sticks to the skin but is not burning. Emergency-room workers can take off these stuck pieces of cloth safely.

• Remove all jewelry, belts and tight clothing on the burned areas and from around the victim’s neck; burned areas swell immediately.

• Call 911, or, if the burn is not too large, take the person to a doctor right away. Don't let the burned person drive.

• If the burned person is conscious and is not vomiting, try to get him or her to drink warm water. The water will help replace fluids lost from the burn.

• Check to see whether a tetanus shot is needed.