Disease and Condition

Burns: First Degree
What is it?

A burn is an injury to the tissues of the body. Burns are classified according to the amount of tissue they affect and how deep they are. A first-degree burn is the least serious type of burn because it injures only the top layers of skin, called the epidermis.
Who gets it?

Anyone can get a first-degree burn. It is difficult to say how many people are affected each year because most do not need to seek medical treatment. Children are especially at risk for first-degree burns from hot water that is greater than 120 degrees Fahrenheit (49 degrees Celsius). Children and the elderly are more likely to experience complications from burns.
What causes it?

First-degree burns are most often caused by brief contact with either dry or moist heat (called a thermal burn) or chemicals; spending too much time in the sun (sunburn); or friction (such as by rubbing the skin against a rug or rope). When a burn is caused by hot water or steam, it is called a scald. The most common sources of heat that cause first-degree burns are hot water, cigarettes, hot grease, and hot beverages.
What are the symptoms?

Skin with a first-degree burn is red, sore, and sensitive to the touch. It may also be moist, slightly swollen, or itchy. Sunburns are often accompanied by headache and low fever. When lightly pressed, the reddened skin whitens, which is called blanching. First-degree burns do not blister and do not leave a scar. See a doctor immediately if a burn is on the face, hands, feet, or genitals; is caused by an electrical source; or covers a very large area.
How is it diagnosed?

Your doctor will examine the burned area and classify it according to the amount of tissue affected and the depth of the burn. He or she will ask how the burn occurred. If the patient is a child, the doctor will ask further questions to ensure the patient is not a victim of child abuse. Doctors assess the severity of a burn by determining what percentage of the total body surface area (BSA) is affected. In patients older than nine years, they apply what’s called the “rule of nines” to determine the percentage of BSA. For example, the genital area is considered 1% of BSA. The head and neck are 9%. Burns on each arm, including the hand, is also 9% of BSA. Each leg, including the foot, is 18%. The front of the torso is 18%, as is the back of the torso, including the buttocks. In children younger than nine, the palm of the child’s hand is used as a measure of 1% of BSA. First-degree burns that cover less than 15% of an adult's body or less than 10% of a child's body are considered minor. First-degree burns that cover 15 to 25% of an adult's body, or 10 to 20% of a child's body, are moderate burns. Those that cover more than 25% of an adult's body or more than 20% of a child's body, as well as those on the face, hands, feet, or genitals, are critical.

What is the treatment?

Minor burns can be treated at home. First, remove any clothing or jewelry from the injured area. Then, hold the burned area under cool running water for around 10 minutes to stop the burning process. You can also use a clean towel or wash cloth moistened with cold water. However, don’t use ice or ice water because they will further damage the tissue. You can place a dry, sterile gauze pad over the burn, but do not use any bandages with adhesive. It is important for the bandage to be loose so the burn gets air. Never apply butter or oils. They make it more difficult for the burn to heal and can actually make the burn worse because the heat can’t escape. You can, however, gently wash the area with an antiseptic cleanser and apply an aloe-based cream to relieve pain. Pain relievers such as acetaminophen, ibuprofen, or aspirin can help with inflammation and pain, and should be used according to directions. Never give aspirin to a child under the age of 18 because of the risk of a serious illness called Reye’s syndrome. Chemical burns are treated a little differently. For liquid chemicals, first remove any clothing or other items that the chemicals have spilled on. Then, thoroughly wash any chemicals off the skin under running water for 15 to 30 minutes. For dry chemicals, use large amounts of water to flush the chemicals from the skin. Never use small amounts of water because they may actually activate the chemicals. If no water is available, use a clean cloth to brush any dry chemicals off the skin. Loosely cover the burn with a dry, sterile bandage. Different chemicals have different effects, so you should always check the chemical label, if possible, for additional directions. Always see a doctor if the chemicals have gotten into the eyes or mouth. First-degree burns usually heal very quickly. The burned skin may peel after a few days, but should not scar. Vitamins C and E, and zinc may help the burn to heal, but should be taken only in safe amounts. Call your doctor immediately if redness and pain do not decrease within a few days; if the redness, pain, swelling, or fever increase; or if there are signs of infection, such as red streaks radiating outward from the burn. Moderate and critical burns should be treated at a hospital. Use the above guidelines for emergency first aid.
Self-care tips

Many burns occur at home and could have been prevented. You can avoid first-degree burns by handling hot liquids and objects carefully. Make sure electrical cords are in good condition, household chemicals are safely stored and labeled, and hot beverages and objects are out of reach of small children. When handling chemicals, wear protective gloves and eyewear, and follow label directions for safe handling. Never wear clothing with long, loose sleeves while cooking or around any type of open fire. Never put a child into a tub unless you have first tested the water temperature. You can guard against burns from hot water by keeping your hot water heater set lower than 120 degrees Fahrenheit (49 degrees Celsius). Children should also sleep in flame-resistant pajamas or nightgowns. Do not smoke, or make sure discarded cigarettes are completely extinguished. Teach your children fire safety and make sure they do not have access to matches or lighters. You can also protect you and your family from burns by making sure you have operating smoke detectors on every floor of your house. Also check the temperature of a child’s car seat or seat belt before buckling the child in. Even these objects can cause burns after a period of time in direct sunlight. Never allow children to handle fireworks without adult supervision. Fireworks are a leading cause of burns and other injuries. You can avoid sunburns by using a sunscreen of at least a 15 SPF rating. Apply sunscreen liberally at least 20 minutes before sun exposure and reapply after swimming or sweating. Avoid spending time in the sun from 10 a.m. to 3 p.m., when the rays are strongest.
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