Burns (Skin) - Causes, Treatment & When to See a Doctor

```html

What is Burns (Skin)?

A burn is an injury to the skin (and sometimes deeper tissues) caused by heat, chemicals, electricity, radiation, or friction. Burns are classified by depth (first‑, second‑, third‑degree) and by the percentage of body surface area involved. The primary problem is loss of the protective skin barrier, which can lead to pain, fluid loss, infection, and scarring. While many minor burns heal at home, more extensive injuries require professional care to prevent complications.

Common Causes

• Thermal heat – hot liquids (scalds), flames, hot surfaces, steam.
• Electrical injury – household wiring, lightning, industrial equipment.
• Chemical exposure – acids, alkalis, bleach, industrial cleaners.
• Radiation – sunburn from ultraviolet (UV) radiation, radiation therapy.
• Friction – road rash from a fall or motorcycle crash.
• Cold injury – frostbite is technically a “cold burn.”
• Contact with hot objects – curling irons, grills, irons, stovetops.
• Flash burns – brief exposure to intense light (e.g., welding, fireworks).
• Immersion injuries – prolonged contact with hot bath water or oil.
• Medical procedures – laser surgery, electrocautery, or chemical peels.

Associated Symptoms

Burns are often accompanied by additional signs that reflect the body’s response to injury:

• Pain that may be severe (especially with first‑ and second‑degree burns).
• Redness (erythema) and swelling.
• Blister formation – fluid‑filled vesicles that indicate a second‑degree burn.
• White, leathery, or charred skin – hallmark of third‑degree burns.
• Heat sensation or a lingering “burning” feeling.
• Systemic signs if a large area is involved: fever, chills, rapid heartbeat, low blood pressure.
• Difficulty breathing if the airway is exposed to smoke or heat.
• Loss of sensation in deeper burns due to nerve damage.

When to See a Doctor

Not every burn needs a medical visit, but you should seek professional care promptly if any of the following apply:

• Burn larger than 3 inches (7.5 cm) in diameter for an adult, or larger than 2 inches (5 cm) for a child.
• Burn covers more than 10 % of total body surface area (TBSA) in adults (or 5 % in children).
• Visible third‑degree burn (white, black, or charred skin) or a deep, painless area.
• Burns on the face, hands, feet, genitals, or over a major joint.
• Signs of infection: increasing redness, pus, foul odor, or fever.
• Persistent severe pain despite over‑the‑counter pain relief.
• Electrical or chemical burns, regardless of size, because of hidden tissue damage.
• Any burn that results in difficulty breathing or swallowing.

Diagnosis

Emergency physicians and primary‑care providers evaluate burns through a combination of visual assessment, history, and occasionally advanced testing.

Clinical assessment

• Depth classification – Determine if the burn is first, second, or third degree.
• TBSA estimation – Use the “Rule of Nines” for adults or the Lund‑Browder chart for children.
• Location – Identify involvement of critical areas (face, airway, hands, feet, groin).
• Signs of infection – Look for erythema beyond the burn margin, purulence, or systemic fever.

Additional investigations (when indicated)

• Laboratory tests: CBC, electrolytes, renal function, and blood cultures if infection is suspected.
• Imaging: X‑ray to assess for underlying bone injury or inhalation injury (airway swelling).
• Blood gas analysis for severe inhalation injuries.
• Biopsy (rare) for atypical burn wounds or to differentiate from necrotizing fasciitis.

Treatment Options

Treatment goals are to relieve pain, prevent infection, promote healing, and minimize scarring.

First‑Aid (Home) Measures

• Cool the burn – Run cool (not icy) water over the area for 10‑20 minutes.
• Remove contaminated clothing/jewelry – Do this before swelling begins.
• Cover with a clean, non‑adhesive dressing – Use sterile gauze or a specialized burn dressing.
• Analgesia – Ibuprofen or acetaminophen; consider short‑acting opioids for severe pain under medical supervision.
• Avoid home remedies such as butter, oil, toothpaste, or “miracle” gels – they can trap heat and increase infection risk.

Medical Treatment

• Fluid resuscitation – For burns >20 % TBSA, intravenous lactated Ringer’s solution according to the Parkland formula.
• Topical antimicrobial agents – Silver sulfadiazine, mafenide acetate, or newer nanocrystalline silver dressings to reduce bacterial colonisation.
• Systemic antibiotics – Indicated only when there is a confirmed infection or high risk (e.g., deep burns).
• Surgical debridement – Removal of dead tissue to prevent infection and prepare the wound for grafting.
• Skin grafting – Autograft, allograft, or synthetic grafts for deep partial‑thickness or full‑thickness burns covering large areas.
• Pain management – Multi‑modal approach: NSAIDs, acetaminophen, opioid rotation, and, when appropriate, ketamine infusions.
• Physical therapy – Early range‑of‑motion exercises to prevent contractures, especially for burns over joints.
• Psychological support – Burns can cause trauma, PTSD, and body‑image issues; counseling is often needed.

Home Care After Initial Treatment

• Change dressings according to physician instructions (usually every 24‑48 hours).
• Keep the wound clean; use mild saline rinses rather than harsh soaps.
• Apply prescribed topical agents (e.g., silicone gel) to flatten scars.
• Monitor for signs of infection (increasing redness, swelling, fever).
• Maintain nutrition – high‑protein, vitamin‑C, and zinc‑rich diet to support healing.
• Protect the wound from sun exposure with SPF 30+ clothing or sunscreen once re‑epithelialized.

Prevention Tips

• Kitchen safety – Keep pot handles turned inward, use oven mitts, and set water heater temperature ≤ 120 °F (49 °C).
• Electrical safety – Inspect cords, use ground‑fault circuit interrupters (GFCIs), avoid handling appliances with wet hands.
• Chemical safety – Wear gloves, goggles, and long sleeves; store acids/alkalis in labelled containers.
• Fire safety – Install smoke detectors, keep a fire extinguisher, and practice “stop, drop, and roll.”
• Sun protection – Apply broad‑spectrum sunscreen, wear hats, and avoid peak UV hours.
• Childproofing – Keep hot liquids out of reach, use stove knob covers, and never leave children unattended near heat sources.
• Workplace precautions – Follow OSHA guidelines for handling hot equipment, chemicals, and electrical parts.
• Proper first‑aid training – Learn how to cool a burn and apply dressings correctly.

Emergency Warning Signs

Key Take‑aways

Burns range from minor scalds that heal with simple first aid to life‑threatening injuries that demand intensive medical care. Understanding the cause, promptly applying appropriate first‑aid measures, and recognizing red‑flag symptoms are essential for optimal outcomes. Prevention—through safety habits at home, work, and outdoors—remains the most effective strategy.

Sources: Mayo Clinic. “Burns.”; CDC. “Burn Prevention.”; National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Burn Injuries.”; WHO. “Prevention of Burn Injuries.”; Cleveland Clinic. “Burn Care and Management.”; J Burn Care Res. 2022;41(4):423‑433.

```