How to Treat Burns

Burns are a common but incredibly painful injury. Minor burns typically heal without the need for extensive medical care, while more severe burns require special attention to prevent infection and minimize significant scarring. Before addressing a burn, it’s important to understand the type of burn – or the degree of burn.

Identify a first-degree burn. First-degree burns are the most common type, usually caused by brief contact with hot objects or sun exposure. The damage is limited to the outermost layer of skin. These burns typically appear red, mildly swollen, and may cause a light stinging sensation or no pain at all. You can treat these at home, as minor burns generally don’t require professional treatment. The outer layer of skin will heal naturally with proper care.

• First-degree burns are categorized as 'minor burns' and are usually treated as such. While some minor burns might need extra attention, such as in the case of sunburns affecting large areas of the body, they do not require medication.

Identify a second-degree burn. The skin may develop spots, blisters, and more intense pain. Second-degree burns occur with quick exposure to extremely hot objects (e.g., boiling water), or prolonged contact with hot materials or sun exposure. Unless the burn is on your hands, feet, groin, or face, you can treat it as a first-degree burn. If blisters form, avoid popping them. If they burst, keep the area clean by rinsing with water and applying an antibacterial ointment. You may cover the area with a bandage or gauze with the ointment applied. Change the bandage daily.

• Second-degree burns damage two layers of skin. If the burn covers more than 8 cm, or is located on the hands, feet, joints, genitals, or doesn’t heal after several weeks, you should consult a doctor for treatment.

Identify a third-degree burn. Third-degree burns are the most severe and require emergency medical attention. These burns occur from prolonged exposure to hot materials and burn all three layers of skin, sometimes affecting muscles, fat, and bones. The burn may appear thick, white, or black. Pain levels may vary depending on the extent of nerve damage in the skin layers (pain receptors). Sometimes, these burns may appear “wet” due to the breakdown of cells and leaking proteins.

• Third-degree burns are always classified as severe and require immediate medical care.

Identify a frostbite burn. These “burns” occur when skin is exposed to extremely low temperatures such as snow or ice for prolonged periods. Affected skin may appear red, white, or black, and feel burning or tingling when it warms up. Frostbite is still considered a burn because it damages the skin’s tissue layers.

• In most cases, frostbite should be treated as a severe burn and requires medical attention.
• Warm the skin in water at a temperature between 37°C and 39°C immediately after exposure to cold.

Identify a chemical burn. Chemical burns occur when skin comes into contact with harmful chemicals, causing damage to the skin’s layers. Chemical burns can appear as red patches, rashes, blisters, and open sores on the skin. The first step is always to identify the chemical involved and immediately contact a poison control center.

• Contact poison control immediately if you suspect a chemical burn. These burns require treatment to neutralize the chemical and prevent further spread.
• Rinse the chemical burn with plenty of water, but avoid washing with water if the burn is caused by dry lime or strong metals (e.g., sodium, magnesium, phosphorus, lithium) as these substances can react with water and cause further damage.

Let cool water run over the burn. Immediately place the burn under cool running water. This helps prevent further skin damage. Hold the affected area under the cool water for about 10-15 minutes, or until the pain starts to subside. Avoid using ice-cold water, as it can damage the skin around the burn.

• Sudden transitions from extreme heat to extreme cold can slow down the healing process.

Quickly remove tight clothing and jewelry. As soon as you can, or while rinsing the burn, remove any tight clothing or jewelry that may be pressing into the skin, especially if swelling is occurring. Take off anything that could be restricting circulation. This will help blood flow to the area and begin the healing process. Removing tight items also prevents further skin damage.

Apply a cold compress. While cold water is not recommended, you can use a cold compress or ice wrapped in a cloth. Apply the compress to the skin for 10-15 minutes, wait 30 minutes, and then reapply for another 10-15 minutes.

• Never apply ice or a cold compress directly to the burn, as it can damage the skin. Always use a cloth as a barrier.

Take over-the-counter pain medication. A pain reliever such as ibuprofen, acetaminophen, aspirin, or naproxen can help ease the discomfort caused by burn symptoms. If the pain persists after several hours, take another dose. Avoid giving aspirin to children or taking it if you have recently recovered from a cold or chickenpox.

• Follow the instructions on the medication packaging. Directions may vary depending on the type of medication you choose.

Clean the burn area. After washing your hands, clean the burn with soap and water to prevent infection. Apply an antibiotic ointment like Neosporin after cleaning to keep the burn area sterile. Aloe vera can also help soothe the skin. Look for aloe vera products with minimal additives. Antibiotic ointment or aloe can also help prevent the bandage from sticking.

• Do not pop any blisters while cleaning the burn, as they protect the skin from infection. Be careful not to burst or leak any fluid from the blisters, as the body can naturally heal small blisters. You don’t need to use antibiotic ointment if the blisters remain intact, but if they break or the wound is open, apply an antibiotic ointment to prevent infection.

Gently apply ointment to the burn and cover it. For a first-degree burn, you might not need a bandage if there are no broken blisters or open wounds. However, small second-degree burns should be covered to prevent infection. Carefully place a gauze over the burn and secure it with medical tape. Change the bandage daily.

• Never place the gauze directly on the wound. Always apply cream or ointment before covering it with gauze. Failing to do so may cause the new skin layer to peel off when removing the bandage.
• Remove the gauze in the direction of hair growth around the wound. If the gauze sticks to the wound, use warm water or saline solution to moisten it and make removal easier. To make the saline solution, mix one teaspoon of salt with about 4 liters of water.

Avoid home remedies like egg whites, butter, or tea. The internet is filled with “miracle” burn cures, but their effectiveness is rarely supported by scientific research. Trusted sources like the Red Cross advise against these remedies, as bacteria in these substances may worsen the condition and lead to infection.

• Natural moisturizers such as aloe vera or soy can be beneficial for sunburns.

Monitor the burn for signs of infection. Watch for changes in the color of the wound, such as redness, brown, or blackening. Additionally, check for any greenish discoloration of the tissue surrounding the burn. If the burn hasn’t healed after several weeks, you should seek medical attention. A burn that doesn’t heal may signal complications, infection, or a more severe burn. Contact your doctor if you notice the following signs:

• warmth at the site
• softness
• hardening around the wound
• fever over 39°C or a temperature lower than 36.5°C (these signs indicate a serious infection and require immediate medical attention)

Ease itching with topical creams. Itching is a common symptom many patients experience during the early stages of healing after a mild burn. Creams like aloe vera or petroleum-based jelly can help soothe the discomfort caused by itching. You may also take antihistamines to help reduce the itching sensation.

Call emergency services immediately. Never attempt to treat a severe burn at home. Severe burns require professional medical attention right away. Call an ambulance, visit a doctor, or go to the emergency room.

• Never try to treat a severe burn on your own. The following are basic first steps you should take while awaiting emergency help:

Move the victim away from the heat source. Do everything possible to stop the burn and injury from worsening. Cut off the heat source or move the victim away from it.

• Never pull or move the victim by touching the burned areas. Doing so may cause additional damage to the skin, potentially open the wound, or worsen an already open wound. This could cause excruciating pain for the victim and lead to shock.

Cover the burn. Place a damp, cool cloth over the burned area to protect it while waiting for emergency services. Do not use ice or immerse the burned skin in cold water. This could cause a sudden drop in body temperature or cause further damage to sensitive areas.

Remove any irritating chemicals. If the burn is caused by chemicals, wash off any remaining chemicals from the skin. Let cool water run over the burned area or apply a cool compress while awaiting help. Do not attempt to use any home remedies on a chemical burn.

Elevate the burned area above the victim's heart. Only do this if you can lift the affected area without causing further harm.

Call emergency services for shock immediately. Watch for shock symptoms: rapid or weak pulse, low blood pressure, cold skin, confusion or unconsciousness, nausea, agitation. If signs of shock occur due to a third-degree burn, call emergency services right away. An ambulance should be called to quickly transport the victim to a hospital. This is the most life-threatening situation in an already dangerous context.

• A third-degree burn can cause shock due to the significant loss of fluids when a large area of skin is burned. The body cannot function properly with such a reduced amount of fluids and blood.

Remove clothing and jewelry. The victim will likely be quickly transferred from the hospital to a burn center for treatment. Therefore, remove any clothing or jewelry that may become tight as the body swells.

• A burn injury can cause swelling to such an extent that certain body parts may experience dangerous compression (compartment syndrome). If this occurs, surgery is needed to relieve the pressure and allow blood flow and nerve function to return.

Monitor vital signs and administer oxygen. In all severe burn cases, the doctor may administer 100% oxygen to the victim by inserting an endotracheal tube. Vital signs must be immediately monitored, enabling the doctor to assess the patient’s current condition and develop a tailored treatment plan.

Rehydrate the victim. Prevent further fluid loss and rehydrate the body using intravenous fluids. The type and amount of fluid administered will depend on the severity of the burn.

Administer pain relievers and antibiotics. Provide pain relief medications to help the victim manage the pain. Antibiotics are also crucial.

• Antibiotics are necessary because the body's primary defense system (the skin) has been compromised, and the medication is essential to prevent bacteria from invading and causing an infection in the wound.

Adjust the patient's diet. The patient's diet should be rich in protein and calories to provide the essential nutrients needed for the body to repair the cells damaged by the burn.

• A victim with third-degree burns or worse should be transported by ambulance (or air ambulance, depending on distance) to the nearest burn treatment center.
• Wash your hands thoroughly before touching or caring for the burn. Wear gloves if available.
• Only use cool, clean, purified water OR a saline solution, if available, for first aid on severe burns. Protect the burn area with sterile or clean cloths while calling for emergency help.
• This advice does not replace medical care. If in doubt, consult a doctor immediately.
• Wrap the burn, whether minor or severe, with plastic wrap if gauze is not available. This helps prevent infection while on the way to the hospital.
• Do not immerse chemical burns in water until the type of chemical is identified, as this could cause the chemical to spread across the skin. Water can worsen some chemical burns, such as those from lime.
• Keep the burn away from harmful substances.
• Aloe vera can be soothing for burn wounds.

• Seek medical attention immediately after sustaining a severe burn. Severe burns cannot heal on their own and require professional care.
• Burns caused by radioactive materials are a distinct and serious type. Call emergency medical services right away if you suspect radiation involvement, and take protective measures for both yourself and the victim.