Cutaneous burns - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Cutaneous burns can usually be managed in an outpatient setting. Early management affects long-term outcome.
Severity is assessed by burn size (% total body surface area) and depth (first to fourth degree).
Initial treatment of minor burns consists of wound cooling, cleaning, and dressing. Pain management and tetanus prophylaxis are important.
Serious burns are most effectively managed in regional burn centers.
Prognosis varies from excellent to poor depending on the severity of the burn. Associated injuries (such as inhalation injury or trauma) adversely affect the prognosis.

Second-degree burn

From Dr Sheridan's personal collection

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

American Burn Association. Advanced burn life support course: povider manual 2018 update. 2018 [internet publication].[Full Text]
International Federation of Red Cross and Red Crescent Societies. International first aid, resuscitation, and education guidelines. 2020 [internet publication].[Full Text]
American Burn Association, American College of Surgeons. Guidelines for the operation of burn centers. J Burn Care Res. 2007 Jan-Feb;28(1):134-41.[Abstract]

Other Online Resources

WHO: fact sheet - burns

Referenced Articles

1. Yin B, He Y, Zhang Z, et al. Global burden of burns and its association with socio-economic development status, 1990-2019. Burns. 2024 Mar;50(2):321-74.[Abstract]
2. James SL, Lucchesi LR, Bisignano C, et al. Epidemiology of injuries from fire, heat and hot substances: global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study. Inj Prev. 2020 Oct;26(1 suppl):i36-45.[Abstract][Full Text]
3. Duke JM, Rea S, Boyd JH, et al. Mortality after burn injury in children: a 33-year population-based study. Pediatrics. 2015 Apr;135(4):e903-10.[Abstract]
4. American Burn Association. Burn incidence and treatment in the United States: 2023 fact sheet. 2023 [internet publication].[Full Text]
5. Stylianou N, Buchan I, Dunn KW. A review of the international Burn Injury Database (iBID) for England and Wales: descriptive analysis of burn injuries 2003-2011. BMJ Open. 2015 Feb 27;5(2):e006184.[Abstract][Full Text]
6. Nassar JY, Al Qurashi AA, Albalawi IA, et al. Pediatric burns: a systematic review and meta-analysis on epidemiology, gender distribution, risk factors, management, and outcomes in emergency departments. Cureus. 2023 Nov;15(11):e49012.[Abstract][Full Text]
7. Merz KM, Pfau M, Blumenstock G, et al. Cutaneous microcirculatory assessment of the burn wound is associated with depth of injury and predicts healing time. Burns. 2010 Jun;36(4):477-82.[Abstract]
8. Sakurai M, Tanaka H, Matsuda T, et al. Reduced resuscitation fluid volume for second-degree experimental burns with delayed initiation of vitamin C therapy (beginning 6 h after injury). J Surg Res. 1997 Nov;73(1):24-7.[Abstract]
9. Kraft R, Herndon DN, Finnerty CC, et al. Occurrence of multiorgan dysfunction in pediatric burn patients: incidence and clinical outcome. Ann Surg. 2014 Feb;259(2):381-7.[Abstract]
10. Shupp JW, Nasabzadeh TJ, Rosenthal DS, et al. A review of the local pathophysiologic bases of burn wound progression. J Burn Care Res. 2010 Nov-Dec;31(6):849-73.[Abstract]
11. Merritt EK, Cross JM, Bamman MM. Inflammatory and protein metabolism signaling responses in human skeletal muscle after burn injury. J Burn Care Res. 2012 Mar-Apr;33(2):291-7.[Abstract]
12. Demling R, Picard L, Campbell C, et al. Relationship of burn-induced lung lipid peroxidation on the degree of injury after smoke inhalation and a body burn. Crit Care Med. 1993 Dec;21(12):1935-43.[Abstract]
13. Breederveld RS, Tuinebreijer WE. Recombinant human growth hormone for treating burns and donor sites. Cochrane database Syst Rev. 2014 Sep 15;(9):CD008990.[Abstract][Full Text]
14. Porro LJ, Herndon DN, Rodriguez NA, et al. Five-year outcomes after oxandrolone administration in severely burned children: a randomized clinical trial of safety and efficacy. J Am Coll Surg. 2012 Apr;214(4):489-502.[Abstract]
15. Peck MD. Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns. 2011 Nov;37(7):1087-100.[Abstract]
16. Gupta M, Gupta OK, Yaduvanshi RK, et al. Burn epidemiology: the Pink City scene. Burns. 1993 Feb;19(1):47-51.[Abstract]
17. Simon PA, Baron RC. Age as a risk factor for burn injury requiring hospitalization during early childhood. Arch Pediatr Adolesc Med. 1994 Apr;148(4):394-7.[Abstract]
18. Ryan CM, Thorpe W, Mullin P, et al. A persistent fire hazard for older adults: cooking-related clothing ignition. J Am Geriatr Soc. 1997 Oct;45(10):1283-5.[Abstract]
19. Turner C, Spinks A, McClure R, et al. Community-based interventions for the prevention of burns and scalds in children. Cochrane Database Syst Rev. 2004;(3):CD004335.[Abstract]
20. Sheridan RL, Hoey ME, Daley WM, et al. Childhood burns in camping and outdoor cooking accidents: a focus for prevention. J Burn Care & Rehabil. 1997;18:369-371.[Abstract]
21. Parbhoo A, Louw QA, Grimmer-Somers K. Burn prevention programs for children in developing countries require urgent attention: a targeted literature review. Burns. 2010;36:164-175.[Abstract]
22. Erdmann TC, Feldman KW, Rivara FP, et al. Tap water burn prevention: the effect of legislation. Pediatrics. 1991;88:572-577.[Abstract]
23. Shults RA, Sacks JJ, Briske LA, et al. Evaluation of three smoke detector promotion programs. Am J Prev Med. 1998;15:165-171.[Abstract]
24. American Burn Association. Advanced burn life support course: povider manual 2018 update. 2018 [internet publication].[Full Text]
25. RCSE Faculty of Pre-Hospital Care & BBA. Consensus on management of burns in pre-hospital trauma care. Sep 2020 [internet publication].[Full Text]
26. Hummel RP 3rd, Greenhalgh DG, Barthel PP, et al. Outcome and socioeconomic aspects of suspected child abuse scald burns. J Burn Care & Rehabil. 1993 Jan-Feb;14(1):121-6.[Abstract]
27. The Royal College of Paediatrics and Child Health. Child protection evidence systematic review on burns. Aug 2022 [internet publication].[Full Text]
28. Canty KW, DeRidder CA. Burns in children: accidental or inflicted? Adv Pediatr. 2023 Aug;70(1):45-57.[Abstract]
29. Sheridan RL, Ryan CM, Petras LM, et al. Burns in children younger than two years of age: an experience with 200 consecutive admissions. Pediatrics. 1997 Oct;100(4):721-3.[Abstract]
30. Wibbenmeyer L, Liao J, Heard J, et al. Factors related to child maltreatment in children presenting with burn injuries. J Burn Care Res. 2014 Sep-Oct;35(5):374-81.[Abstract]
31. Quiroz HJ, Parreco JP, Khosravani N, et al. Identifying abuse and neglect in hospitalized children with burn injuries. J Surg Res. 2021 Jan;257:232-8.[Abstract]
32. Cancio L, Lundy J, Sheridan RL. Evolving changes in the management of burns and environmental injuries. Surg Clin North Am. 2012 Aug;92(4):959-86.[Abstract]
33. Heimbach D, Engrav L, Grube B, et al. Burn depth: a review. World J Surg. 1992 Jan-Feb;16(1):10-5.[Abstract]
34. Peck MD, Weber J, McManus A, et al. Surveillance of burn wound infections: a proposal for definitions. J Burn Care Rehabil. 1998 Sep-Oct;19(5):386-9.[Abstract]
35. Roujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. N Engl J Med. 1994 Nov 10;331(19):1272-85.[Abstract]
36. Hettiaratchy S, Papini R. Initial management of a major burn: II - assessment and resuscitation. BMJ. 2004 Jul 10;329(7457):101-3.[Abstract][Full Text]
37. International Federation of Red Cross and Red Crescent Societies. International first aid, resuscitation, and education guidelines. 2020 [internet publication].[Full Text]
38. Sheridan R. Outpatient burn care in the emergency department. Pediatr Emerg Care. 2005 Jul;21(7):449-56.[Abstract]
39. NHS Children's Acute Transport Service. Clinical guidelines: burns management. 2022 [internet publication].[Full Text]
40. British Burn Association. National burn care referral guidance. 2012 [internet publication].[Full Text]
41. American Burn Association, American College of Surgeons. Guidelines for the operation of burn centers. J Burn Care Res. 2007 Jan-Feb;28(1):134-41.[Abstract]
42. Bettencourt AP, Romanowski KS, Joe V, et al. Updating the burn center referral criteria: results from the 2018 eDelphi Consensus Study. J Burn Care Res. 2020 Sep 23;41(5):1052-62.[Abstract]
43. Koyro KI, Bingoel AS, Bucher F, et al. Burn guidelines--an international comparison. Eur Burn J. 2021; 2(3):125-39.[Full Text]
44. Palmieri TL, Taylor S, Lawless M, et al. Burn centre volume makes a difference for burned children. Pediatr Crit Care Med. 2015 May;16(4):319-24.[Abstract]
45. Sheridan RL, Greenhalgh D. Special problems in burns. Surg Clin North Am. 2014 Aug;94(4):781-91.[Abstract]
46. Sheridan RL, Weber JM, Pasternack MS, et al. Antibiotic prophylaxis for group A streptococcal burn wound infection is not necessary. J Trauma. 2001 Aug;51(2):352-5.[Abstract]
47. Rosanova MT, Stamboulian D, Lede R. Systematic review: which topical agent is more efficacious in the prevention of infections in burn patients? Arch Argent Pediatr. 2012 Aug;110(4):298-303.[Abstract][Full Text]
48. Wounds International. International best practice guidelines: effective skin and wound management of noncomplex burns. May 2014 [internet publication].[Full Text]
49. Aziz Z, Abu SF, Chong NJ. A systematic review of silver-containing dressings and topical silver agents (used with dressings) for burn wounds. Burns. 2012 May;38(3):307-18.[Abstract]
50. Gravante G, Caruso R, Sorge R, et al. Nanocrystalline silver: a systematic review of randomized trials conducted on burned patients and an evidence-based assessment of potential advantages over older silver formulations. Ann Plast Surg. 2009 Aug;63(2):201-5.[Abstract]
51. Rigo C, Roman M, Munivrana I, et al. Characterization and evaluation of silver release from four different dressings used in burns care. Burns. 2012 Dec;38(8):1131-42.[Abstract]
52. Wasiak J, Cleland H, Campbell F, et al. Dressings for superficial and partial thickness burns. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD002106.[Abstract][Full Text]
53. Tang H, Lv G, Fu J,et al. An open, parallel, randomized, comparative, multicenter investigation evaluating the efficacy and tolerability of Mepilex Ag versus silver sulfadiazine in the treatment of deep partial-thickness burn injuries. J Trauma Acute Care Surg. 2015 May;78(5):1000-7.[Abstract]
54. Gee Kee EL, Kimble RM, Cuttle L, et al. Randomized controlled trial of three burns dressings for partial thickness burns in children. Burns. 2015 Aug;41(5):946-55.[Abstract]
55. Tyack Z, Simons M, Spinks A, et al. A systematic review of the quality of burn scar rating scales for clinical and research use. Burns. 2012 Feb;38(1):6-18.[Abstract]
56. Sheridan R. Closure of the excised burn wound: autografts, semipermanent skin substitutes, and permanent skin substitutes. Clin Plast Surg. 2009 Oct;36(4):643-51.[Abstract]
57. Hultman CS, Edkins RE, Lee CN, et al. Shine on: review of laser- and light-based therapies for the treatment of burn scars. Dermatol Res Pract. 2012;2012:243651.[Abstract][Full Text]
58. Donelan MB, Parrett BM, Sheridan RL. Pulsed dye laser therapy and z-plasty for facial burn scars: the alternative to excision. Ann Plast Surg. 2008 May;60(5):480-6.[Abstract]
59. Sheridan RL. Burn care: results of technical and organizational progress. JAMA. 2003 Aug 13;290(6):719-22.[Abstract]
60. Garren BN, Akhondi-Asl A, DePamphilis MA, et al. Factors associated with mechanical ventilation duration in pediatric burn patients in a regional burn center in the United States. Pediatr Crit Care Med. 2022 Nov 1;23(11):e536-40.[Abstract]
61. Romanowski KS, Palmieri TL, Sen S, et al. More than one third of intubations in patients transferred to burn centers are unnecessary: proposed guidelines for appropriate intubation of the burn patient. J Burn Care Res. 2016 Sep-Oct;37(5):e409-14.[Abstract]
62. Eskes A, Vermeulen H, Lucas C, et al. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds. Cochrane Database Syst Rev. 2013 Dec 16;(12):CD008059.[Abstract][Full Text]
63. Guilabert P, Usúa G, Martín N, et al. Fluid resuscitation management in patients with burns: update. Br J Anaesth. 2016 Sep;117(3):284-96.[Abstract][Full Text]
64. Semler MW, Self WH, Wanderer JP, et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med. 2018 Mar 1;378(9):829-39.[Abstract][Full Text]
65. Zampieri FG, Machado FR, Biondi RS, et al. Effect of intravenous fluid treatment with a balanced solution vs 0.9% saline solution on mortality in critically ill patients: the BaSICS randomized clinical trial. JAMA. 2021 Aug 10;326(9):1-12.[Abstract][Full Text]
66. Finfer S, Micallef S, Hammond N, et al. Balanced multielectrolyte solution versus saline in critically ill adults. N Engl J Med. 2022 Mar 3;386(9):815-26.[Abstract]
67. Lewis SR, Pritchard MW, Evans DJ, et al. Colloids versus crystalloids for fluid resuscitation in critically ill people. Cochrane Database Syst Rev. 2018 Aug 3;8:CD000567.[Abstract][Full Text]
68. Greenhalgh DG, Cartotto R, Taylor SL, et al. Burn resuscitation practices in North America: results of the Acute Burn ResUscitation Multicenter Prospective Trial (ABRUPT). Ann Surg. 19 Aug 2021 [Epub ahead of print].[Abstract]
69. Callum J, Skubas NJ, Bathla A, et al. Use of intravenous albumin: a guideline from the international collaboration for transfusion medicine guidelines. Chest. 2024 Mar 4:S0012-3692(24)00285-X.[Abstract][Full Text]
70. Food and Drug Administration. Labeling changes on mortality, kidney injury, and excess bleeding with hydroxyethyl starch products. July 2021 [internet publication].[Full Text]
71. European Medicines Agency. PRAC recommends suspending hydroxyethyl-starch solutions for infusion from the market. Feb 2022 [internet publication].[Full Text]
72. White CE, Renz EM. Advances in surgical care: management of severe burn injury. Crit Care Med. 2008 Jul;36(7 Suppl):S318-24.[Abstract]
73. Hanson MD, Gauld M, Wathen CN, et al. Nonpharmacological interventions for acute wound care distress in pediatric patients with burn injury: a systematic review. J Burn Care Res. 2008 Sep-Oct;29(5):730-41.[Abstract]
74. Sheridan RL, Stoddard FJ, Kazis LE, et al; Multi-Center Benchmarking Study. Long-term posttraumatic stress symptoms vary inversely with early opiate dosing in children recovering from serious burns: effects durable at 4 years. J Trauma Acute Care Surg. 2014 Mar;76(3):828-32.[Abstract]
75. Oremus M, Hanson MD, Whitlock R, et al. A systematic review of heparin to treat burn injury. J Burn Care Res. 2007 Nov-Dec;28(6):794-804.[Abstract]
76. Oremus M, Hanson M, Whitlock R, et al. The uses of heparin to treat burn injury. Evid Rep Technol Assess (Full Rep). 2006 Dec;(148):1-58.[Abstract][Full Text]
77. Sheridan RL, Chang P. Acute burn procedures. Surg Clin North Am. 2014 Aug;94(4):755-64.[Abstract]
78. Kesting MR, Wolff KD, Hohlweg-Majert B, et al. The role of allogenic amniotic membrane in burn treatment. J Burn Care Res. 2008 Nov-Dec;29(6):907-16.[Abstract]
79. Latenser BA. Critical care of the burn patient: the first 48 hours. Crit Care Med. 2009 Oct;37(10):2819-26.[Abstract]
80. Faucher LD, Conlon KM. Practice guidelines for deep venous thrombosis prophylaxis in burns. J Burn Care Res. 2007 Sep-Oct;28(5):661-3.[Abstract]
81. Ryan CM, Lee A, Kazis LE, et al; Multicenter Burn Outcome Group. Recovery trajectories after burn injury in young adults: does burn size matter? J Burn Care Res. 2015 Jan-Feb;36(1):118-29.[Abstract]
82. Sheridan RL, Lee AF, Kazis LE, et al; Multi-Center Benchmarking Study Working Group. The effect of family characteristics on the recovery of burn injuries in children. J Trauma Acute Care Surg. 2012 Sep;73(3 Suppl 2):S205-12.[Abstract]
83. Gonçalves N, Ciol MA, Dantas RA, et al. A randomized controlled trial of an educational programme with telephone reinforcement to improve perceived health status of Brazilian burn victims at 6-month post discharge. J Adv Nurs. 2016 Oct;72(10):2508-23.[Abstract]
84. Schneider JC, Nadler DL, Herndon DN, et al. Pruritus in pediatric burn survivors: defining the clinical course. J Burn Care Res. 2015 Jan-Feb;36(1):151-8.[Abstract]
85. Vaghela KR. Plastic surgery and burns disasters: what impact do major civilian disasters have upon medicine? Bradford City Football Club stadium fire, 1985, King's Cross Underground fire, 1987, Piper Alpha offshore oil rig disaster, 1988. J Plast Reconstr Aesthet Surg. 2009 Jun;62(6):755-63.[Abstract]
86. Morris LD, Louw QA, Grimmer-Somers K. The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review. Clin J Pain. 2009 Nov-Dec;25(9):815-26.[Abstract]
87. Lambert V, Boylan P, Boran L, et al. Virtual reality distraction for acute pain in children. Cochrane Database Syst Rev. 2020 Oct 22;10:CD010686.[Abstract][Full Text]
88. Dylewksi ML, Baker M, Prelack K, et al. The safety and efficacy of parenteral nutrition among pediatric patients with burn injuries. Pediatr Crit Care Med. 2013 Mar;14(3):e120-5. [Abstract]
89. Shoham Y, Krieger Y, Goverman J. Anacaulase-bcdb for the treatment of severe thermal burns. Expert Opin Biol Ther. 2023 Jul-Dec;23(12):1185-91.[Abstract]
90. Shoham Y, Rosenberg L, Hickerson W, et al. Early enzymatic burn debridement: results of the DETECT multicenter randomized controlled trial. J Burn Care Res. 2024 Mar 4;45(2):297-307.[Abstract]
91. Claes KEY, Amar S, Hoeksema H, et al. Pain management during a bromelain-based selective enzymatic debridement in paediatric and adult burn patients. Burns. 2022 May;48(3):555-67.[Abstract]
92. Kahn SA, Carter JE, Wilde S, et al. Autologous skin cell suspension for full-thickness skin defect reconstruction: current evidence and health economic expectations. Adv Ther. 2024 Mar;41(3):891-900.[Abstract][Full Text]
93. Holmes JH. A brief history of RECELL® and its current indications. J Burn Care Res. 2023 Jan 2;44(suppl_1):S48-9.[Abstract][Full Text]
94. Larson KW, Austin CL, Thompson SJ. Treatment of a full-thickness burn injury with novosorb biodegradable temporizing matrix and RECELL autologous skin cell suspension: a case series. J Burn Care Res. 2020 Jan 30;41(1):215-9.[Abstract][Full Text]
95. Pellegrino JL, Charlton NP, Carlson JN, et al. 2020 American Heart Association and American Red Cross focused update for first aid. Circulation. 2020 Oct 21;142(17):e287-303.[Full Text]
96. Jacobs DG, Jacobs DO, Kudsk KA, et al. Practice management guidelines for nutritional support of the trauma patient. J Trauma. 2004 Sep;57(3):660-78.[Abstract]
97. Sheridan RL. Sepsis in pediatric burn patients. Pediatr Crit Care Med. 2005 May;6(3 suppl):S112-9.[Abstract]
98. Jiang Q, Chen J, Tian F, et al. Silicone gel sheeting for treating hypertrophic scars. Cochrane Database Syst Rev. 2021 Sep 26;9:CD013357.[Abstract][Full Text]
99. Stoddard FJ Jr, Sorrentino E, Drake JE, et al. Posttraumatic stress disorder diagnosis in young children with burns. J Burn Care Res. 2017 Jan/Feb;38(1):e343-51.[Abstract]
100. Sheridan RL. Fire-related inhalation injury. N Engl J Med. 2016 Aug 4;375(5):464-9.[Abstract]
101. Sheridan RL, Remensnyder JP, Schnitzer JJ, et al. Current expectations for survival in pediatric burns. Arch Pediatr Adolescent Med. 2000 Mar;154(3):245-9.[Abstract]
102. Patterson DR, Ptacek JT, Cromes F, et al. The 2000 clinical research award: describing and predicting distress and satisfaction with life for burn survivors. J Burn Care Rehabil. 2000 Nov-Dec;21(6):490-8.[Abstract]
103. Sheridan RL, Hinson MM, Liang MM, et al. Long-term outcome of children surviving massive burns. JAMA. 2000 Jan 5;283(1):69-73.[Abstract][Full Text]