Burns
Symptoms, Causes & Treatment
Understanding burns: how to assess severity, what first aid to give, when to go to A&E, and how burns are treated in hospital and at home.
What Are Burns?
A burn is an injury to the skin (and sometimes deeper tissues) caused by heat, chemicals, electricity, radiation, or friction. Burns are among the most common household injuries, with approximately 175,000 people attending emergency departments in England and Wales each year for burns and scalds.
The severity of a burn depends on its depth, the area of body surface affected, and its location. Most minor burns can be safely managed at home or with primary care support. More significant burns require specialist assessment and may need hospital treatment.
What Do Burns Look Like?
Burn appearance, depth, and associated symptoms guide assessment and appropriate management.
First-degree: redness, pain, no blistering (sunburn-like) · Second-degree: blistering, deep pain, pink/red moist skin · Third-degree: white, brown, or black leathery skin, no pain (nerve damage) · Fourth-degree: charred skin, extends to muscle/bone
Burns covering >10% body surface area in adults or >5% in children · Burns to face, hands, genitals, feet, or joints · Full-thickness (third-degree) burns of any size · Electrical or chemical burns · Inhalation injury (singed nose hairs, hoarse voice, soot) · Burns in children or the elderly — all attend A&E
Go to A&E immediately for any burn larger than the patient’s palm, burns to the face/hands/feet/genitals, burns in children or elderly, chemical or electrical burns, or burns with white/charred skin.
What Causes Burns?
Burns are caused by exposure to thermal, chemical, electrical, or radiation energy that damages skin and underlying tissue.
Thermal burns damage skin by protein denaturation and cell death from heat energy. The zone of coagulation (central necrosis) is surrounded by a zone of stasis (potentially salvageable) and zone of hyperaemia.
Contact dermatitis occurs when skin comes into contact with an irritant (irritant contact dermatitis) or a specific allergen (allergic contact dermatitis via type IV delayed hypersensitivity). Common allergens: nickel, latex, fragrances, preservatives.
Common eczema triggers include wool, synthetic fabrics, dust mites, pet dander, pollen, mould, soaps, detergents, food allergens (in children), and emotional stress. Identifying and avoiding personal triggers reduces flare frequency.
Psoriasis is an immune-mediated chronic inflammatory skin disease. T-cell activation drives rapid keratinocyte proliferation (3–5 days instead of 28–30), producing the characteristic thickened plaques.
Multiple psoriasis triggers are recognised: streptococcal throat infection (especially guttate psoriasis), medications (lithium, beta-blockers, antimalarials, NSAIDs), stress, trauma (Koebner phenomenon), alcohol, and smoking.
Around 30% of people with skin psoriasis develop psoriatic arthritis — an inflammatory arthropathy with joint erosions, enthesitis, and dactylitis. It can be severe and requires DMARD treatment to prevent joint destruction.
Key Risk Factors
How Are Burns Assessed?
Burns are assessed clinically by depth, size (%BSA), location, and mechanism. Lund and Browder chart estimates BSA accurately. Circumferential burns and burns to the face/hands/perineum require specialist assessment.
How Are Burns Treated?
Treatment is matched to burn depth and size. Minor burns are managed with wound care. Major burns require specialist burns unit management.
Supportive Measures
After cool running water for 20 minutes: cover with cling film (loosely) or a non-adherent dressing. Take paracetamol and ibuprofen for pain. Keep the wound clean and moist. Follow up with a GP or practice nurse for wound review if healing is not progressing normally.
Long-Term Burns Scar Management
Healing burns require long-term scar management. Silicone gel or sheets applied for 12 hours daily for 6–12 months reduce hypertrophic scarring. Pressure garments are used for large burns. Physiotherapy prevents contracture formation. Psychological support is important for patients with significant burns.
When Should You Seek Medical Advice for a Burn?
Burn larger than patient’s palm · Any burn to face, hands, feet, genitals, or joints · Burns in children under 5 or adults over 60 · Chemical or electrical burn · White or charred (full thickness) skin · Burn with smoke inhalation.
Burn is not healing as expected after 2 weeks · Burn shows signs of infection (increasing redness, warmth, pus, odour) · You want wound care advice for a minor burn · Burn is sunburn in a child causing blistering.
How Can You Prevent Burns?
Most burns are preventable. These measures significantly reduce the risk of burn injuries at home and work.
Never use ice to cool a burn — it causes vasoconstriction and worsens tissue injury. Do not apply butter, toothpaste, or cling film other than for transport. Cool with running water for 20 minutes then cover with a clean, non-fluffy dressing.
Chickenpox spreads by airborne droplets and direct contact. Keep infected children at home until all blisters have crusted (typically 5 days from rash onset). Inform school and close contacts, especially pregnant women and immunocompromised individuals.
Frequent, effective milk removal is the most important mastitis prevention. Feed or express every 2–3 hours; never skip feeds. Get breastfeeding support from a midwife, health visitor, or lactation consultant early — before problems develop.
Ensure your baby latches on deeply and correctly. A poor latch causes nipple trauma (cracks), which are an entry point for bacteria. Ask for a latch assessment if breastfeeding is painful.
Seek breastfeeding support immediately if you notice breast hardness, redness, or pain. Early identification and treatment of blocked ducts prevents progression to mastitis and abscess.
SPF 30+ sunscreen daily is the single most effective measure against all types of hyperpigmentation, including melasma, PIH, and solar lentigines. UV exposure stimulates melanin even on cloudy days. Apply year-round to face and neck.
Speak to a Clinician About Burns
Through The GP Service, a licensed clinician can assess minor burns, advise on wound care, and refer urgently to a burns unit where needed.
Expert clinical advice, when you need it.
Burns FAQs
Superficial burns affecting only the outer skin layer (epidermis) typically heal within 3–5 days without scarring. Partial thickness burns take 14–21 days. Full thickness burns require specialist management and often skin grafting.
Call 999 or go to A&E immediately for any burn larger than the size of the patient's palm, any burn to the face, hands, feet, genitals, or joints, all burns in children under 5 or adults over 60, all chemical or electrical burns, and any burn with white or charred skin.
Cool the burn under cool (not cold) running water for 20 minutes. Remove jewellery and clothing from the area unless stuck to skin. Cover with cling film or a clean non-fluffy dressing. Do not use ice, butter, or toothpaste.
Never apply ice, butter, toothpaste, egg white, or any household remedy to a burn. These increase infection risk, worsen tissue damage, and interfere with healing. Cool running water for 20 minutes is the only appropriate first aid.
Do not burst burn blisters — they act as a protective barrier against infection. If blisters break naturally, cover with a clean dressing. Large or infected blisters should be assessed by a clinician.
Sunburn is an ultraviolet radiation burn to the skin. It causes pain, redness, peeling, and in severe cases blistering. Cool compresses, ibuprofen, and moisturisers help. Blistering sunburn, particularly in children, requires medical assessment.
All partial thickness and full thickness burns carry some risk of scarring. Prompt and appropriate first aid, professional wound care, and avoiding sun exposure to healing skin all reduce scarring risk. Silicone gel or sheets can improve established scars.
Chemical burns require immediate irrigation with large amounts of cool running water for at least 20 minutes. Remove contaminated clothing carefully. Do not try to neutralise the chemical. Call 999 or go to A&E. Bring the chemical container if safe to do so.