Burns
What are burns?
A burn is an injury or damage to the skin or other tissue that is caused by heat, UV radiation, electricity, chemicals or friction. Burns can vary in their severity from minor to life-threatening. The most common cause of burns is thermal (caused by heat), in particular those caused by hot drinks, food, fats and cooking oils. In Australia, there are about 50,000 burns-related hospital admissions per year, with the home being the most common location where burns occur.
Types of burns
Burns used to be classified in degrees (e.g. first-degree, second degree, etc.). Now burns are classified according to their depth as follows4 5:
Epidermal
Epidermal — These involve the epidermal layer (outer layer of skin) only and will usually heal within a few days. Sunburn is a good example of an epidermal burn.
Superficial dermal partial thickness
Superficial dermal partial thickness — This involves the epidermis and the upper part of the dermis. The burn may appear bright pink or red and there may or may not be blisters present.
Mid dermal partial thickness
Mid dermal partial thickness — This type of injury involves the entire layer of the epidermis along with large amounts of the dermis. The underlying dermis may vary in colour from pale to dark pink. Pain is usually less severe than superficial burns due to damage to nerve endings.
Deep dermal partial thickness
Deep dermal partial thickness — These burns damage the epidermis and a large amount of the dermis. Within hours, extensive blisters develop which usually rupture, to expose the damaged dermis underneath. The outer layer of skin may also peel off. These deeper burns tend to be dry compared to more superficial burns. They may not be as painful due to nerve damage.
Full thickness
Full thickness — Full thickness burns destroy both layers of skin (epidermis and dermis) and may involve underlying structures such as muscle or bone. The burn usually appears black or charred and white fatty tissue may be exposed. Because nerve endings are usually destroyed, there is little or no pain at the site of a full thickness burn. However, surrounding tissue not burned as deeply will be painful.
Regardless of the depth of the burn, a major burn is defined as one that:
involves more than 20% of the total body area of an adult.
involves more than 10% of the total body surface of a child.
Major burns are a medical emergency and require urgent treatment.
What causes burns?
Burns can be caused by many factors. Scalds, caused by hot water, hot water bottles, steam or hot oil are the most common causes of burns — even more common than sunburn. Other causes of burns include:
radiation (e.g sunburn, over-exposure to x-ray)
hot solids (e.g. hot ovens or stovetops, frying pans, candle wax, heaters, hair straighteners)
flames (e.g. fireplaces, BBQs)
electricity, including lightning
chemicals (e.g. bleach, concrete mix, drain or toilet cleaners, solvents, metal cleaners, chlorine, phosphorous, petrol)
friction (e.g. skin is scraped off by contact with surfaces such as roads, gravel, carpets, or treadmills)
Who is at risk of burns
Anyone can be at risk of burns. However, research has shown that those most at risk are:
children aged under 4 years
older adults — one in eight adult burns patients are over 65 years of age
Statistics also show that males are more likely to be hospitalised for burns than females, and Indigenous Australians are 2.7 times more like to be hospitalised compared with non-Indigenous Australians.
First aid for burns
Immediately cooling a burn is a critical step in first aid for burns. Unfortunately, only 70% of children and 60% of adults receive appropriate first aid when they sustain a burn.
For epidermal/superficial burns:
Apply cool running water for 20 minutes to the burn, up to three hours after sustaining the injury as reduces burn size, depth and assists with pain management.
If on fire:
Stop, drop to the ground, cover face and roll to smother the fire
Smother flames with a fire blanket
Move away from the source of heat
Follow the first aid protocol
If it’s a chemical burn:
Wash off the chemical immediately with a large quantity of water and continue to do so for up to 60 minutes
Remove contaminated clothing or footwear but do not remove anything that is stuck to the skin
Follow the first aid protocol
First aid protocol
Regardless of the type of burn, first aid for burns is the same. You should:
REMOVE clothing and jewellery (including nappies in the case of children) as clothing can hold heat, and jewellery can prevent blood flow to the burnt area if swelling occurs. Do not remove clothing if it is stuck to a burn.
COOL the burn for no more and no less than 20 minutes. If running water is not available, spray cool water on the burn, or wet 2 cloths and apply to the burn every 30 seconds, alternating between cloths, and re-wetting them to keep cool.
COVER the burn loosely with cling wrap or a clean, damp lint-free cloth.
DO NOT use the following products on a burn, as they are not effective and may cause further damage to the skin:
ice
butter
toothpaste
creams
bandages
When to see a doctor
Most small burns and scalds will heal themselves in around 10 to 12 days and won’t require medical treatment. However, you should call an ambulance (000) if:
the burn is larger than a 20-cent piece
the burn involves the airway, face, hands or genitals
the burn is deep, even if it seems painless
the skin looks leathery
there are patches of brown, black or white
chemicals or electricity caused the burn
the patient is having trouble breathing
How are burns treated?
Burn treatment aims to control pain, remove dead tissue, prevent infection and reduce scarring. Treatment for a burn will depend upon the type of burn and how severe it is.
Epidermal burns, including sunburn will usually heal within a few days and won’t require medical treatment. However, you may wish to take over-the-counter (OTC) pain relief if necessary.
Superficial burns may require pain relief, dressings and regular check-ups with your doctor to ensure the burn doesn’t get infected.
Treatment for deep or serious burns may involve:
pain relief medication (both OTC or prescription)
a cool shower
intravenous fluids through a drip
dressings
antibiotics if the burn becomes infected
possible admission to hospital or a burns unit
surgery, including skin grafts or amputation (usually if a limb is not able to be saved)16
What are the complications of a burn?
There is the potential for someone with burns to develop complications. These will depend upon the type of burn and the severity. They may include:
injury to the lungs from smoke inhalation
loss of fluid from the burned skin, leading to shock
hypothermia, as burnt skin cannot properly regulate temperature
infection which may lead to sepsis (infection of the bloodstream)
scarring, disfigurement and potentially problems with bones and joints
How to prevent burns?
Fortunately, you can take steps to prevent burns and scalds by following these tips:
always use sun protection when out in the sun, including a broad-spectrum, water-resistant sunscreen (SFP 30+)
ensure all hot liquids are out of reach of children
turn pot handles inwards on the stove
wear heat-resistant oven mits when handling hot pots and pans
unplug electrical items when not in use
have a working smoke detector and a fire extinguisher in your home
use protective clothing (i.e. gloves, glasses, etc.) when using chemicals
store chemicals safely, especially out of reach of children
ensure tap water is below 50⁰C to prevent scalds
take care around fireplaces and heaters and consider using a protective screen if you have young children
Your local MediADVICE pharmacist can help you manage your health and recommend a range of products to assist with the symptoms of burns, including dressings and pain relief medication. Speak to your MediADVICE pharmacist about your symptoms so we can recommend products and medications that may be suitable for you.
Find a store