Burns and Scalds

Burns and scalds are common. It’s thought that every one and a half minutes, someone in the UK is burnt or scalded in an accident (i). Serious burns and scalds are also more common than you may think. The most recent figures from the International Burn Injury Database suggest NHS burns services treat more than 15,000 people for burns and scalds every year (ii). Many of these people face very long and painful treatment, not to mention the permanent scars that burns and scalds can cause.

Most at risk from burns and scalds in the home are the very young and the very old. RoSPA claims hot drinks cause most scalds to children under the age of five (iii). Even hot bath water can be a danger to young children, and is responsible for the highest number of fatal and severe scalding injuries among young children (around 2,000 attend A&E departments every year following a scald caused by hot bath water (iii)).

Older people – particularly those who are frail or in poor health – have the highest risk of being fatally injured from burns and scalds, says RoSPA (iv) – four to five times the risk of the population as a whole. Many are affected by contact burns from radiators, electric fires and cookers, as well as scalds caused by kettles.

Types of burns

Burns and scalds cause heat damage to the skin – a burn is caused by dry heat (an electric fire, for instance, or an iron) while scalds are caused by something wet, such as hot water or steam. Both are treated in the same way, and the term ‘burn’ is often used to include scalds.

According to the NHS there are four main types of burn (v):

Superficial epidermal burn

This is where the epidermis – the outer layer of skin – is damaged, resulting in red, slightly swollen and painful but not blistered skin.

Superficial dermal burn

With this type of burn the epidermis and part of the dermis – the layer of tissue just beneath the epidermis – are both damaged. This makes your skin pale pink and painful, plus it may cause blisters.

Deep dermal or partial thickness burn

In this case the epidermis and the dermis are damaged, making your skin red and blotchy, turning swollen and blistered. The skin with a deep dermal or partial thickness burn may be dry or moist, and can be either very painful or painless.

Full thickness burn

This type of burn damages all three layers of the skin, namely the epidermis, dermis and the subcutis (the deeper layer of fat and tissue). These burns aren’t necessarily painful, because the nerve endings in the dermis have been destroyed. The skin, however, will look white or charred black.

You may have more than one type of burn if you have an accident – that is, some areas may be superficial while others may be partial or full thickness.

Other types of burns include electrical burns, which may cause damage inside the body even with little to no damage to the skin; chemical burns (where the skin or internal organs are damaged by chemical substances such as strong acids); and burns caused by radiation energy (sunburn, for instance, is caused by UV radiation from the sun).

First aid for burns and scalds

Treating burns and scalds as quickly as possible can help limit how much damage they do to your skin. Here is the first aid advice from the NHS on treating burns (vi):

• Stop the burning process as soon as possible. This may mean removing the person from the area, dousing flames with water, or smothering flames with a blanket. Don't put yourself at risk of getting burnt as well.

• Remove any clothing or jewellery near the burnt area of skin, including babies' nappies. However, don't try to remove anything that's stuck to the burnt skin as this could cause more damage.

• Cool the burn with cool or lukewarm running water for 20 minutes, as soon as possible after the injury. Never use ice, iced water, or any creams or greasy substances such as butter.

• Keep yourself or the person warm.
  Use a blanket or layers of clothing, but avoid putting them on the injured area. Keeping warm will prevent hypothermia, where a person's body temperature drops below 35C (95F). This is a risk if you are cooling a large burnt area, particularly in young children and elderly people.

• Cover the burn with cling film.
  Put the cling film in a layer over the burn, rather than wrapping it around a limb. A clean clear plastic bag can be used for burns on your hand.

• Treat the pain from a burn with paracetamol or ibuprofen. Always check the manufacturer's instructions when using over-the-counter medication. Children under 16 years of age should not be given aspirin.

• Sit upright as much as possible if the face or eyes are burnt. Avoid lying down for as long as possible as this will help to reduce swelling.

Promptly applied first aid can be extremely helpful for burns, but some may also need professional treatment. All chemical and electrical burns should be treated in hospital, as should burns on the face, hands, arms, feet, legs or genitals that cause blisters. Similarly, you should go quickly to A&E if a burn of any size has made the skin turn white or charred black, or if a burn is large or deep (a large burn is bigger than the affected person’s hand).

Other circumstances where you need professional medical treatment include the following:

• The injured person is a pregnant woman, is over the age of 60 or a child under the age of five.

• The injured person has a medical condition such as diabetes or heart disease.

• The injured person has a weakened immune system.

• There are other injuries besides the burn that need treatment.

• The injured person has also been exposed to smoke or fumes.

Preventing burns and scalds in the home

There are several things you can do to make a burn or scald less likely in your household.

First, keep toddlers out of the kitchen whenever possible (use a safety gate if necessary). Switch to a cordless kettle – or a kettle with a very short or coiled cord – to prevent the cord hanging over the edge of the worktop where it could be pulled over.

It’s also a good idea to use the cooking rings at the back of your hob, and to get into the habit of turning your saucepan handles away from the front of the cooker (again to prevent them being pulled over).

At bath time, put cold water in the bath first, then add hot – and always test the temperature with your elbow before stepping in yourself or putting a child in. You may also want to consider fitting a thermostatic mixing valve on your bath taps to control the temperature of your bath water – though always check the temperature of the water first, as even with a thermostatic mixing valve water can be hot enough to cause discomfort. Never leave young children alone in the bathroom, not even for a second.

Drinks danger

According to RoSPA, hot drinks cause the biggest number of scalds to children under the age of five (iii). Indeed, even 15 minutes after you’ve made a hot drink, the liquid can still scald a child, since children’s skin is much more sensitive than that of an adult. This is why it’s important to never hold a hot drink and a child at the same time (always put your drink down before holding a baby or child). It’s also important to put hot drinks out of reach and away from the edges of tables and worktops.

Older people may have difficulties carrying hot liquids from one room to another, so consider rearranging their tea/coffee-making area so that they’re not carrying hot drinks further than necessary.

Meanwhile, hair straighteners can cause serious burns for up to 40 minutes after they’ve been used. So keep things like curling tongs and straighteners out of the reach of children, even when they’ve been switched off and are cooling down.

Also make sure things like matches, lighters and lit candles are placed out of children’s sight and reach, and fit fireguards to all your fires and heaters. To prevent sunburn, read our article on sun protection .

Preventing burns on bonfire night

The latest figures from NHS Digital show that more than 2,000 firework injuries were seen at A&E departments in England during 2018/19 (vii), many of which were likely to have been burn injuries.

It seems it doesn’t matter how many official safety warnings are published every year, since far too many people (adults and children) are having accidents during fireworks displays. And it’s not just on November 5th, since other occasions such as Diwali, New Year’s eve and Chinese New Year also involve fireworks.

The safest place to enjoy fireworks is at a large public display, as figures show far fewer people are injured at large displays than at smaller gatherings (viii). If, however, you’re having a fireworks party at home, make sure you’re prepared for any accidents that might happen. This means making sure you have the following:

• First aid kit.

• Fire blanket.

• Bucket of sand.

• Plenty of water (including a bucket of water).

• Sterile saline solution for eyes.

Also remember that children and young people should only ever watch fireworks at a safe distance – do not allow them to set up, light or dispose of fireworks (only adults should do that). Make sure children are also supervised whenever they are in the presence of a bonfire, and that those who are responsible for the bonfire wear appropriate clothes (avoid wearing anything loose and tie back long hair). Also never pour petrol, paraffin or meths on a fire (fire lighters are a safer alternative). 

In the meantime, here are 10 more tips from RoSPA (viii) to make sure your fireworks party is as safe as possible:

1. Plan your firework display to make it safe and enjoyable.

2. Keep fireworks in a closed box and use them one at a time.

3. Read and follow the instructions on each firework using a torch if necessary.

4. Light the firework at arm’s length with a taper and stand well back.

5. Keep naked flames, including cigarettes, away from fireworks.

6. Never return to a firework once it has been lit.

7. Don’t put fireworks in pockets and never throw them.

8. Direct any rocket fireworks well away from spectators.

9. Never use paraffin or petrol on a bonfire.

10. Make sure that the fire is out and surroundings are made safe before leaving.

 

Natural relief for burns and scalds

There are several natural treatments for reducing the pain of burns as well as supporting skin healing. One traditional way to treat superficial burns is to apply raw honey – indeed, there is some evidence this may help skin heal faster than when using conventional bandages (ix).

Similarly aloe vera gel is often recommended as a treatment for minor burns. However, unlike honey, there’s no evidence as yet that aloe vera is effective. Interestingly, potato peel has proved successful as a treatment for burns, with one study suggesting it may be an effective alternative to conventional bandages (x).

Nutritional supplements that may help with skin repair include

Anthocyanidins – plant pigments found in richly coloured fruit such as blueberries, blackberries, cranberries, raspberries and black grapes – are thought to be useful for collagen repair (it’s believed they may help strengthen collagen). Collagen is the substance that give skin its structure, and can be destroyed when the skin suffers a burn.

Vitamin C and Vitamin E are antioxidants, and thought to help support skin healing (vitamin E can be swallowed or applied topically). There is also some evidence that these nutrients – either on their own or taken together – may be helpful for preventing and treating sunburn (xi).

Zinc may be helpful too, both for immune support and skin repair, and studies suggest it may be beneficial for those with severe burns (xii).

For advice on a range of other common health concerns, our health library has a number of helpful articles.
 

 

References:

1. Available online: https://www.humanics-es.com/burns.pdf

2. Available online: https://www.cbtrust.org.uk/news-and-events/burn-accidents-costing-the-nhs-20-million-per-annum-show-latest-statistics-released-on-national-burn-awareness-day/

3. Available online: https://www.rospa.com/resources/hubs/keeping-kids-safe/burns-scalds

4. Available online: https://www.rospa.com/home-safety/advice/older-people

5. Available online: https://www.nhs.uk/conditions/burns-and-scalds/

6. Available online: https://www.nhs.uk/conditions/burns-and-scalds/treatment/

7. Available online: https://www.england.nhs.uk/2019/11/demand-for-nhs-burns-care-soars-over-bonfire-night-and-diwali/

8. Available online: https://www.rospa.com/home-safety/advice/fireworks-safety

9. Norman G. et al., Antiseptics for burns. Cochrane Database Syst Rev. 2017 Jul ;2017(7): CD011821. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483239/

10. Subrahmanyam. M. Honey impregnated gauze versus polyurethane film (OpSite) in the treatment of burns-a prospective randomised study. Br J Plast Surg. 1993;46:322-333.
    
    Molan. P. Potential of honey in the treatment of wounds and burns. Am J Clin Dermatol. 2001;2:13-19.
    
    Jull. AB, Rodgers. A, Walker. N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2008;4:CD005083.

11. Keswan. MH, Patil. AR. The boiled potato peal as a burn wound dressing: a preliminary report. Burns Incl Therm Inj. 1985;11:220-224.

12. Trevithick. JR, Shum. DT, Redae. S, et al. Reduction of sunburn damage to skin by topical application of vitamin E acetate following exposure to ultraviolet B radiation: effect of delaying application or of reducing concentration of vitamin E acetate applied. Scanning Microsc. 1993;7:1269-1281.
    
    Darr. D, Combs .S, Dunston. S, et al. Topical vitamin C protects porcine skin from ultraviolet radiation-induced damage. Br J Dermatol. 1992;127:247-253.
    
    Darr. D, Dunston. S, Faust. H, et al. Effectiveness of antioxidants (vitamin C and E) with and without sunscreens as topical photoprotectants. Acta Derm Venereol. 1996;76:264-268.
    Traikovich. SS. Use of topical ascorbic acid and its effects on photodamaged skin topography. Arch Otolaryngol Head Neck Surg. 1999;125:1091-1098.
    
    Eberlein-Knig. B, Placzek. M, Przybilla. B. Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-alpha-tocopherol (vitamin E). J Am Acad Dermatol. 1998;38:45-48.

13. Kirmis . R, Greenwood. J, Aromataris. E. Trace Element Supplementation Following Severe Burn Injury: A Systematic Review and Meta-Analysis. J Burn Care Res. 2003;37(3):143-59.Available online: https://academic.oup.com/jbcr/article-abstract/37/3/143/4582082

14. Berger. MM, Spertini. F, Shenkin. A, et al. Trace element supplementation modulates pulmonary infection rates after major burns: a double-blind, placebo-controlled trial. Am J Clin Nutr. 1998;68:365-371.
    
    Han. CM, et al. Changes in body zinc and copper levels in severely burned patients and the effects of oral administration of ZnSO4 by a double-blind method [in Chinese; English abstract].
    Chinese journal of plastic surgery and burns. 1990; 6:83-86, 155.

Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

---