A cigarette burn is a specific type of thermal contact injury caused by sustained contact with the glowing ember of a lit cigarette. This concentrated heat source creates a small, localized wound that is distinct from other common burn types. This article describes the visual profile of these injuries, from the acute stage through the healing process and as a permanent scar.
Acute Visual Profile of the Injury
The immediate appearance of a cigarette burn is highly characteristic due to the nature of the heat source and the duration of contact. These injuries typically present as a perfectly circular or slightly ovoid lesion, generally measuring between 0.8 to 1.0 centimeter in diameter, which matches the size of a cigarette ember.
The intense, sustained heat delivered over a small area often results in a deep injury, frequently reaching deep partial-thickness (second-degree) or full-thickness (third-degree) depth. The center of the wound exhibits coagulative necrosis, appearing pale, white, or gray because the tissue has been killed by the heat. This necrotic tissue may present as a dry, leathery base or a “punched-out” ulceration.
Surrounding the pale center is a sharply demarcated ring of erythema, or redness, caused by inflammation in the adjacent, less-damaged skin. The uniform application of heat from a cigarette creates clear, sharp borders. In some instances, a blister may form around the perimeter in the acute phase, separating the deep central damage from the surrounding living tissue.
The Progression of Healing and Scar Formation
The healing process for a deep cigarette burn begins with the formation of a dark, hard scab called eschar over the necrotic tissue. This eschar serves as a natural barrier but must eventually separate from the underlying viable tissue. This separation can take several weeks depending on the burn’s depth.
Once the eschar detaches, the wound bed is often a red, granulated tissue that slowly contracts and epithelializes from the edges inward. Because these burns often penetrate deeply into the dermis, they almost always result in permanent scarring. The resulting scar tissue is frequently either atrophic (thin and depressed below the surrounding skin) or hypertrophic (raised and thickened).
The final appearance of the healed mark often retains the original circular or oval shape of the injury. Scars may exhibit depigmentation (appearing lighter than the surrounding skin due to the destruction of melanocytes) or hyperpigmentation (appearing darker). Scars that are raised and extend beyond the original wound boundary are known as keloids, a potential outcome for deep injuries.
Distinguishing Characteristics from Other Burns
The morphology of a cigarette burn allows it to be differentiated from other common thermal injuries, such as scalds or contact with different hot objects. The key differentiating features are the uniformity of the injury depth and the sharp, well-defined border. Scald burns, caused by hot liquids, typically have irregular, flowing margins and a non-uniform depth due to the liquid cooling as it runs across the skin.
Contact burns from other hot objects, such as irons or heating elements, may also leave a pattern, but the pattern is generally larger or reflects the specific shape of the implement (e.g., a grid or a square). A cigarette burn’s small, perfectly circular shape is highly specific and rarely mirrored by accidental contact with other household items. Accidental contact burns are often more shallow and less defined.
The depth of the cigarette burn, often full-thickness in the center, is a distinguishing feature from most accidental burns, which are typically more superficial. The combination of the small, uniform diameter, the deep central tissue damage, and the distinct, circular margin sets the visual profile of a cigarette burn apart from other types of thermal trauma.