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Burns - The Rule of Nines
Burns - The Rule of Nines

Burn - First Degree
Burn - First Degree

First Aid - Burn - Chemical
First Aid - Burn - Chemical

First Aid - Burn - Thermal
First Aid - Burn - Thermal

Burn - Second Degree
Burn - Second Degree

  • A burn is a heat (thermal), chemical or electrical injury to the skin.

General Information

  • Thermal burns are skin injuries caused by heat. Common examples are burns from hot water or hot drinks. Other common causes of thermal burns include hot ovens, stoves, electric or kerosene space heaters, exhaust pipes, hot grease, hair-curling irons, and clothes irons.
  • Chemical burns result from lye, acids, or other tissue-damaging chemicals splashed on the skin. If the chemical is washed off immediately, most of these accidents will cause only first-degree burns.

Degrees of Burn Severity

  • 1st Degree Burn (superficial burns): Reddened skin without blisters (usually doesn't need to be seen)
  • 2nd Degree Burn (partial thickness burns): Reddened skin with blisters (heals from bottom up, takes 2 to 3 weeks)
    • Small closed blisters (narrower than 1 inch) serve as a dressing and reduce pain. Also the blister fluid contains protective chemicals.
    • Large closed blisters (wider than 1 inch) may need debridement. They commonly break open and the dead skin then needs to be removed.
    • All open blisters need trimming of the dead skin (can be done by you or in the doctor's office). Most open blisters are empty of fluid. A blister with a small opening and slow fluid leak can be recognized by the appearance of wrinkled skin.
  • 3rd Degree Burn (full thickness burns): Deep burn with white or charred skin. The burned area loses sensation to pain and touch (feels numb). Usually needs a skin graft to prevent bad scarring if it is larger than a quarter (1 inch or 2.5 cm) in size.

If not, see these topics

First Aid:

FIRST AID Advice for Thermal Burns

  • Immediately (don't take time to remove clothing) put the burned part in cold tap water or pour cold water over it for 10 minutes. For burns on the face, apply a cold wet washcloth. (Reason: lessens the depth of the burn and relieves pain)

FIRST AID Advice for Chemical Burns

  • Immediately remove any contaminated clothing.
  • Then flush the chemical off the skin with warm water for 10 minutes. For large areas, use a shower.
When to Call Your Doctor

Call 911 Now (you may need an ambulance) If
  • Large 2nd or 3rd degree burn
  • Difficulty breathing with burn to the face
  • Difficulty breathing after exposure to flames, smoke, or fumes
  • NOTE: For all above thermal and chemical burns, see First Aid
Call Your Doctor Now (night or day) If
  • You think you have a serious burn
  • Blister is present (EXCEPTION: small closed blister less than ½ inch wide)
  • Center of the burn is white or charred
  • Burn completely circles an arm or leg
  • Eye or eyelid burn
  • Electrical current burn
  • Explosion or gun powder caused the burn
  • Acid or alkali (lye) burn
  • Chemical on skin that causes a blister
  • NOTE: For all above thermal and chemical burns, see First Aid
  • Hoarseness or cough after exposure to flames, smoke, or fumes
  • Headache or nausea after exposure to flames, smoke, or fumes
  • Burn looks infected
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think you need to be seen
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Diabetes and mild burn of foot or lower leg
Self Care at Home If
  • Mild thermal or chemical burn and you don't think you need to be seen

Thermal Burns
  1. Reassurance: A mild thermal or chemical burn can be treated at home.
  2. Cleansing: Wash the area gently with an antibacterial liquid soap and water once a day.
  3. Blisters:
    • Do not open any small closed blisters; the outer skin protects the burn from infection.
    • For small broken blisters, trim off the dead skin with a fine scissors (Reason: the area under these flaps of skin can become an ideal breeding ground for infection). Sometimes gently wiping the burn with a wet washcloth will easily remove the thin blister skin.
  4. Antibiotic Ointment: For burns with broken blisters, apply an over-the-counter antibiotic ointment (e.g., Bacitracin) and cover it with some gauze or a Band-Aid (Reason: to decrease pain and risk of infection). Change the dressing daily.
  5. Tetanus Shot: If your last tetanus shot was more than 10 years ago, you need a booster. Call your doctor during regular office hours (within the next 3 days).
  6. Expected Course: It will probably hurt for 2 days and peel like a sunburn in about a week. Fortunately, first and second-degree burns do not leave scars.
  7. Pain Medication:
    • For pain relief, take acetaminophen or ibuprofen.
    • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
    • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
    • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
    • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
    • CAUTION: Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  8. Call Your Doctor If:
    • Severe pain persists more than 2 hours after giving pain medicine.
    • Burn starts to look infected (pus, red streaks, increased tenderness)
    • You become worse
Burning Sensation from Hot Peppers
  1. General Information:
    • Handling Hot Peppers: Handling certain types of chili peppers can cause skin irritation and burning pain. This usually resolves without any skin damage. The burning pain should resolve over 1 hour.
    • Biting a Hot Pepper: Biting a hot pepper causes a painful burning sensation of the involved skin or mucous membranes. The discomfort usually last 10-20 minutes. The skin will not blister or be damaged in any way.
  2. Treatment for Skin Pain from Handling Hot Peppers:
    • WASH the skin with soap and warm water, to remove the pepper oils.
    • COVER the painful skin area with vegetable oil (for hands/fingers soak in vegetable oil) for 1 hour. The vegetable oil absorbs the pepper oils and will slowly reduce the pain. If vegetable oil is not available, you can try using milk or cream (dairy products contain a substance that absorbs the pepper oil). Dairy products that are "fat-free" will not work.
  3. Treatment for Mouth Pain from Handling Hot Peppers:
    • RINSE your mouth several times with milk or cream.
    • Dairy products contain a substance that absorbs the pepper oil.
  4. Call Your Doctor If:
    • Pain persists > 1 hour
    • Blisters appear
    • You become worse.

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 1/19/2009

Last Revised: 4/2/2009

Content Set: Adult HouseCalls Online

Portions Copyright 2000-2009 Self Care Decisions LLC; Copyright LMS, Inc.

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