To distinguish a minor burn from a serious burn, the first step is to determine the degree and the extent of damage to body tissues. These three classifications will help you determine emergency care:
The least serious burns are those in which only the outer layer of skin (epidermis) is burned. The skin is usually red, with swelling and pain sometimes present. The outer layer of skin hasn’t been burned through. Treat a first-degree burn as a minor burn unless it involves substantial portions of the hands, feet, face, groin or buttocks or a major joint.
When the first layer of skin has been burned through and the second layer of skin (dermis) also is burned, the injury is termed second-degree burn. Blisters develop and the skin takes on an intensely reddened, splotchy appearance. Second-degree burns produce severe pain and swelling.
If the second-degree burn is no larger than 2 to 3 inches in diameter, treat it as a minor burn. If the burned area is larger or if the burn is on the hands, feet, face, groin or buttocks or over a major joint, get medical help immediately.
For minor burns, including second-degree burns limited to an area no larger than 2 to 3 inches in diameter, take the following action:
Cool the burn. Hold the burned area under cold running water for 15 minutes. If this is impractical, immerse the burn in cold water or cool it with cold compresses. Cooling the burn reduces swelling by conducting heat away from the skin. Don’t put ice on the burn.
Consider a lotion. Once a burn is completely cooled, applying an aloe vera lotion, a triple antibiotic ointment or a moisturizer prevents drying and makes you feel more comfortable.
Cover the burn with a sterile gauze bandage. Don’t use fluffy cotton, which may irritate the skin. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the area, reduces pain and protects blistered skin.
Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others).
Minor burns usually heal in about one to two weeks without further treatment. They may heal with pigment changes, meaning the healed area may be a different color from the surrounding skin. Watch for signs of infection such as increased pain, redness, fever, swelling or oozing. If infection develops, seek medical help. Avoid re-injuring or tanning if the burns are less than a year old — doing so may cause more extensive pigmentation changes. Use sunscreen on the area for at least a year.
Don’t use ice. Putting ice directly on a burn can cause frostbite, further damaging your skin.
Don’t break blisters. Fluid-filled blisters protect against infection. If blisters break, wash the area with mild soap and water, then apply an antibiotic ointment and a gauze bandage. Clean and change dressings daily. Antibiotic ointments don’t make the burn heal faster, but they can discourage infection. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment. If it’s a major burn, don’t apply any ointment at all (see below).
The most serious burns are painless and involve all layers of the skin. Fat, muscle and even bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning or other toxic effects may occur if smoke inhalation accompanies the burn.
For major burns, dial 911 or call for emergency medical assistance. Until an emergency unit arrives, follow these steps:
Don’t remove burnt clothing. However, do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat.
Make sure the burn victim is breathing. If breathing has stopped or you suspect the person’s airway is blocked, try to clear the airway and, if necessary, do cardiopulmonary resuscitation (CPR).
Cover the area of the burn. Use a cool, moist sterile bandage or clean cloth.