How to treat burns–and when to go to the doctor

by James Hubbard, M.D., M.P.H.

Continuing our skin-care series this week (see “Related Posts” at the end of this entry for more), I’ll now cover burns.

There a few general things to remember in treating burns caused by external heat.

  1. They are not immediately life-threatening unless they pose a risk to your airway from damage or swelling of your face or neck, or involve 10 percent or more of your skin surface.
  2. You can estimate skin surface by the rule of nines.  Each arm accounts for 9 percent total body surface, as does your face, including neck.  Each leg is 18 percent.  The front part of your trunk is 18 percent, as is the back part.  The last 1 percent goes for the genital area.  Another estimate is your palm is close to 1 percent.
  3. The first thing to do is to try to limit the damage.  Remove any hot or restrictive items and run cold water over the affected area.  Don’t use ice because it may constrict needed blood flow to the area.  Never use grease, butter or ointments that may hold the heat in.
  4. The first assessment on how to treat depends on surface area and depth of skin damage (degree).Aside from what I’ve already said, and assuming no associated injuries, seek medical advice if a second-degree burn covers more than 5 percent of your body or you suspect a third-degree burn. (See below for definitions of each.) The more area involved, the more urgency to see the doctor.

As always, this is general information, not specific recommendations.  I’m assuming you’re a healthy adult.  Many groups should be much more cautious, such as babies, the elderly or those with chronic disease.

First-Degree Burn

  • Typically, these are the mild sunburns that make your skin red and painful.  Try cool compresses or aloe vera gel, along with anti-inflammatories for pain (never aspirin for children, however).  The burn should heal in a few days with resultant sloughing of the damaged top layer of skin.

Second-Degree Burn

  • Blistering is its calling card, which may occur immediately or after several hours.  Infection is the worry.
  • These burns usually heal in two or three weeks with minimal scarring, but you need to keep them clean and protected.
  • Leave intact small blisters alone since they act as a sterile bandage.
  • Puncture blisters greater than an inch in diameter since they’re probably going to leak, anyway.
  • Once you puncture a blister or it starts draining on its own, take some tweezers to pull up the loose tissue as you cut it away with scissors.  Wash the wounds with soap and water; towel dry; apply antibiotic ointment, gauze and tape.  Change the dressing daily or if it gets wet or dirty.  Clean off any dirt or crust buildup, then reapply the ointment and bandage.
  • If the redness starts moving into the healthy skin, you need an oral antibiotic.

Third-Degree Burn

  • This burn is all the way through the skin layers.  The skin is initially blanched or speckled white or gone.
  • Since nerve fibers have been killed, it may not hurt as bad as other burns and even be numb.  If you can’t get to a doctor (though you should), treatment is the same as for second-degree.  Depending on the amount of surface area, these will take months to heal.  Scarring is inevitable.  It’s important to keep affected joints as mobile as possible to prevent restrictive scars.

Fourth-Degree Burn

  • These involve fat tissue or deeper.  They require skin grafts to heal.

Also remember my post on skin functions.  One is to retain or store body fluids.  If the burn involves 10 to 20 percent of the body, you must drink a lot of liquids to avoid dehydration.  A larger surface area may require special IV fluids.  Keeping affected extremities elevated can help swelling.

Please comment, add or critique.

Doctors and business owners: Send customized issues of James Hubbard’s My Family Doctor to your customers or patients. E-mail publisher-at-familydoctormag.com for details.

As with all information on this site, this article cannot replace professional, personal medical advice. Read more here.

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18 Responses to “How to treat burns–and when to go to the doctor”

  1. Dr. J Says:

    I have a vivid memory of burning myself with a stick from a fire when eight years old! I found a glass bottle, filled it with cold water I found in a puddle, and kept my hand in the bottle as I road home on my bike. When I arrived home 10 minutes or so later, my mother put butter on the burn :-( Perhaps that was the moment I knew I was meant to be a doctor :-)

    Dr. Js last blog post..On changing habits, willpower and weight gain

  2. James Hubbard Says:

    Dr. J,

    Your mother is no exception. Many people still do that.

    James Hubbards last blog post..How to Help a Loved One: depression, alcoholism, addiction …

  3. cathy Says:

    Good stuff! I didn’t know about not using ice.

    cathys last blog post..Chewing the fat – or rather spitting it out

  4. Sagan Says:

    Neat to learn about how much each body part takes up for surface percentage! And good to get this information out BEFORE summer.

    Sagans last blog post..Interpretations of Marketing Strategies: The Evolution of Advertising

  5. James Hubbard Says:

    Thanks Sagan

    Cathy For the first few minutes it’s ok to rub some ice on very small burns (nickel size) with intact skin.

    James Hubbards last blog post..How to Help a Loved One: depression, alcoholism, addiction …

  6. Steve Parker, M.D. Says:

    Thanks for the CME, Dr Hubbard. I don’t even remember learning about 4th degree burns.

    Regarding 4th degree burns, I saw a documentary on TV recently about “spontaneous human combustion.” The “combustion” was slowly (or quick?) burning fat tissue of a dead body. Like a candle. Gruesome, but interesting. I had thought SHC was an urban myth. Still might be.

    -Steve

    Steve Parker, M.D.s last blog post..Does the Atkins Diet Increase Cardiovascular Risk?

  7. Judy Rodman Says:

    A keeper for the archives, Dr. Hubbard.

    Judy Rodmans last blog post..Recording Producer: How Do You Pick One?

  8. FatFighterTV Says:

    Unfortunately I have had a few first- and second-degree burns in my time – I am a little klutzy in the kitchen (actually, klutzy everywhere)! But thankfully, no infections.

    FatFighterTVs last blog post..5 ways to track how much water you drink

  9. James Hubbard Says:

    FightfighterTV I’ve touched a few hot skillets myself.

    James Hubbards last blog post..Top-10 Medication Mistakes: Doctors’ tips for taking your medicine

  10. ocbody.com doc Says:

    Burns can be harder to manage without skilled help as deeper burns taking longer to heal result in poorer scarring. I generally recommend skin grafting for any burn that is too large to be closed (by healing itself) within two weeks. This helps minimize poor scarring.

    I also tend to recommend xeroform gauze for burns on the hands and fingers as clean moisture helps them heal. This impregnated gauze features an antibacterial and moisture, so it and stays in place better than dry gauze and reduces pain from dressing changes. Having a low index to get to a plastic surgeon for larger burns or those on the hands, fingers or face is probably reasonable.

    ocbody.com docs last blog post..Which Karhashian will go under the Knife?

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  14. Jonathan Paul Says:

    If a person has been burned badly by fire, fast action on your part is very important. Firstly, make the victim lie down. Place the victim’s head and chest a little lower than the rest of his body. Then raise the victim’s legs if possible and call the hospital for immediate medical help.

  15. Jonathan Paul Says:

    All third degree burns require immediate emergency medical care.

    For minor burns

    Toothpaste in theory has a very high capacity for drawing out heat, and it seams that it does not have complication as long as it is applied without poking at the damaged area or you are allergic to it.It need to be applied within a couple of minutes of the incident.After 30 minutes, this method probably would not do much. Consult your medical professional at that time.
    Be sure not to break the blisters if they do form, as it is also can lead to infections.
    do not want to apply any type of butter to or anything oil base such as ointment to the burn since it will entrap heat in the injured tissues, which can potentially cause more damage and increase your chance of developing an infection and delay healing.
    If infection develops, seek medical help.
    Avoid tanning if the burns are less than a year old as it may cause more extensive pigmentation changes. Use sunscreen on the area for at least a year..

    :-)
    Keep blogging

  16. Bobbie Says:

    I burned my arm on the stove element. Did not hurt too bad. It has been 4 days and it is bleeding and hurting really bad. I am on Plavix. It started off just a narrow white stripe on my arm just below my elbow. 5 x as wide now with blood under the blisters. Trip to the Doc?

  17. Linda Says:

    my husband burned his inner leg by his knee, its about 6×4 all the skin came off is that a 3rd degree burn. I have told him he should go see a dr.
    what do you think it is very pink around the burn.

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