A thermal burn is an injury to the skin and underlying tissues caused by contact with an external heat source like fire, hot liquids, steam, or heated surfaces. This type of burn is distinct from those caused by chemicals, electricity, or radiation. Thermal burns are the most prevalent type of burn injury requiring specialized medical care. The severity of the damage depends on the temperature of the heat source and the duration of contact with the skin.
Common Causes of Thermal Burns
Scalds are a primary cause of thermal burns, resulting from exposure to hot liquids like boiling water or beverages, or from contact with steam. These are particularly common among young children. Another major category is contact burns, which happen when skin touches a hot object, such as a stove, an iron, or hot pavement.
Flame burns occur from direct exposure to fire, such as from a candle, a kitchen fire, or mishaps with flammable materials. These burns can also lead to inhalation injuries if they occur in an enclosed space, as the person may breathe in hot gases or smoke. Flash burns are a related injury caused by the intense, brief energy from an explosion or an electrical arc, where the extreme heat can cause significant skin damage.
Understanding Burn Degrees
The severity of a thermal burn is classified into degrees, indicating the depth of damage to the skin’s layers. A first-degree burn is the mildest form, affecting only the epidermis, the outermost layer of skin. This burn appears red, is painful, and may be warm to the touch, but it does not form blisters. Sunburn is a common example, and these burns heal within a week without scarring.
Second-degree burns involve damage to both the epidermis and the underlying dermis. These burns are characterized by redness, pain, and the formation of blisters. The affected area might look moist or wet and may turn pale or white when pressed, a phenomenon known as blanching. Healing can take several weeks, and there is a risk of scarring and changes in skin pigmentation.
Third-degree burns, also known as full-thickness burns, extend through all layers of the skin and can damage the underlying fat, muscle, or even bone. The burn site may appear white, leathery, or charred. A notable characteristic is the absence of pain in the affected area itself, as the nerve endings in the skin have been destroyed. These injuries do not heal on their own and require medical intervention, often involving skin grafts.
At-Home First Aid Response
For minor burns, such as first-degree and small second-degree burns, immediate first aid can reduce tissue damage. The first step is to move the person away from the heat source and immediately cool the affected area under cool, running water for at least 10 to 20 minutes. This action helps to dissipate heat from the skin and can lessen the depth and pain of the injury.
After cooling the burn, gently remove any jewelry or restrictive clothing from around the affected area before swelling begins. If clothing is stuck to the burn, do not try to pull it off; instead, carefully cut around the adhered fabric. Cover the area loosely with a sterile, non-stick bandage or a clean cloth to protect it from friction. Over-the-counter pain relievers can be used to manage discomfort.
Never apply ice directly to a burn, as extreme cold can cause further tissue damage. Avoid using home remedies like butter, oils, or lotions, as these can trap heat and increase the risk of infection. It is also important not to break any blisters that form, as the blister provides a natural barrier against bacteria. If a blister breaks on its own, clean the area gently with mild soap and water and apply an antibiotic ointment.
When to Seek Medical Attention
While many minor burns can be managed at home, certain characteristics indicate the need for professional medical evaluation. Any third-degree burn requires immediate emergency treatment. You should also see a doctor if any of the following conditions apply:
- A second-degree burn is larger than the palm of the affected person’s hand.
- Any burn is located on the face, hands, feet, genitals, or over a major joint.
- The burn affects a very young child or an elderly person.
- A burn completely encircles a limb or body part (a circumferential burn).
- There are signs of an inhalation injury, such as coughing, wheezing, or facial burns.
- The wound shows signs of infection, including increased pain, redness, swelling, fever, or oozing.
Professional Burn Treatment Options
For burns that require medical care, treatment is focused on preventing complications, managing pain, and promoting healing. In a hospital, the initial steps involve cleaning the wound to remove dead tissue and contaminants, a process called debridement. To prevent infection, doctors apply topical antibiotic ointments and specialized dressings designed to keep the wound moist and protected.
Patients with large burns are at risk of severe dehydration due to fluid loss from the damaged skin. To counteract this, intravenous (IV) fluids are administered to maintain hydration and support organ function, which helps manage “burn shock.” Pain management is another component of care, often requiring prescription medications to keep the patient comfortable during healing.
For deep second-degree and all third-degree burns where the skin cannot regenerate, surgical intervention is necessary. The most common procedure is skin grafting, where healthy skin is taken from an unburned area of the patient’s body and transplanted onto the burn wound. This process provides a permanent covering for the wound, reduces scarring, and restores function. Recovery from severe burns is often a long process that may involve multiple surgeries and physical therapy.