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Harvard Medical School

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Emergency Know-How
Emergency Know-How
InteliHealth Medical Content

Reviewed by the Faculty of Harvard Medical School

Appropriate initial treatment can limit the severity of burns.
First-degree (superficial) burns are the least serious and most common burns. They cause tenderness or pain and skin redness similar to sunburn.
Rinse and cool a first-degree burn under a gentle stream of running water. Then apply a cold-water compress — a water-soaked clean towel or cloth — until the pain eases. Don't apply ice, which can further injure the skin, and avoid folk remedies such as butter or mud, which increases the risk of infection.
After rinsing and cooling the burn, apply a burn ointment if one is recommended by your doctor or pharmacist. Cover the injury with a dry, sterile dressing, such as a gauze pad. Continue this self-treatment, changing the dressing daily, until the burn is no longer painful.
Second-degree (partial thickness) burns extend into a deeper layer of skin. These painful injuries leave the skin with blotchy white, pink or red patches, and they cause blisters that may ooze fluid.
Do not break a blister, as this could increase the risk of infection. Because severely burned skin is not an effective barrier to infection, serious second-degree burns may require antibiotics. Because burned skin can allow fluid to evaporate from your body, you may require intravenous fluid replacement. If partial thickness burns are small, they can be treated like first-degree burns.
The pain of first- or second-degree burns can usually be controlled with over-the-counter products such as aspirin, Tylenol (acetaminophen) or Motrin (ibuprofen). Some second-degree burns may require narcotic pain medication for relief.
Third-degree (full thickness) burns — burns in the most severe of the three grades — extend through all layers of the skin and may injure tissue beneath skin, so the skin is not capable of healing itself. The skin is leathery and dry and has a white, brown, charcoal-gray or deep red appearance. Areas that have full thickness burns do not blister because the layers of skin and tissue adhere to each other, preventing fluid pockets. There may be little or no pain.
When to call a doctor
  • Young or old patients. Any time a burn occurs in an infant or an elderly person, a doctor should evaluate the injury.
  • Chemical burns. These special cases include burns from gasoline or other solvents.
  • Large burns. Call a doctor for a first-degree burn that covers a large area (more than 15 percent) of the body or for any second-degree burn larger than two inches in diameter. Large blisters may need to be drained by a doctor in order to allow healing.
  • Burns on the face, hands or genitals. The skin in these areas is more delicate, and the risk of infection both to the wound site and neighboring areas is greater.
  • Blistered areas around the mouth and nose. These could indicate injury to the airway.
  • Infection concerns. If you have a fever or increasing redness, swelling or drainage occurs at the burn site, call your doctor.
  • Tetanus risks. All patients with second- and third-degree burns also need to have up-to-date tetanus shots. If you have not had a tetanus vaccine in the past ten years, see a doctor today for a booster shot. If you have not completed the introductory tetanus series of three shots (usually given in infancy, but given to adults who were not vaccinated earlier), it is especially important to see a doctor right away. You may need to receive a special shot to immediately fight off the effects of tetanus
  • All third-degree burns.


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Last updated October 17, 2011

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