When the skin is exposed to excessive heat (as from fire), electricity, or corrosive chemicals, the resulting tissue damage is known as a burn. Burns are generally categorized as follows, according to the severity of tissue damage:

Between 1 and 2 million Americans seek medical attention for burns each year. Most burns occur at home, at work, or are part of an injury from a motor vehicle accident. Between 50,000 and 70,000 people are hospitalized for burns every year in the United States, 30% to 40% of whom are children younger than 15 years of age. All burns—even minor ones—may cause functional or cosmetic damage if they are not properly cared for. Skin is a natural barrier to infection, so when it is burned a person loses that protection. Because people who sustain a burn are very prone to developing infections, treatment usually involves preventing or eliminating infections.

Signs and Symptoms

In general, signs and symptoms of burns differ according to the severity of the burn (as described above). Evaluation of the extent of the burn (that is, the amount of skin or body surface area that the burn covers) is important as well because it helps a healthcare practitioner assess the risk for such complications as infection, dehydration, and/or disfigurement.


People who sustain a burn are very prone to infection. Unfortunately, knowing if an infection is present or not is often difficult because the skin surrounding a burn is usually red, and changes in body temperature (a sign of infection). This also a normal response to a large or deep burn. Any change in the appearance of the burn or in the way that the burn victim feels should be brought to the attention of a physician. Potential signs of infection include: Dehydration
A burn injury can lead to loss of fluid through the skin. If dehydration is suspected, a physician who will decide whether or not intravenous fluid is necessary. Potential signs of dehydration include: Burn Patterns
Burns have typical and atypical patterns—typical patterns result from unintentional burns while atypical patterns may be a sign of physical abuse. Typical burns (from spilling hot liquid, for example) tend to occur in exposed areas such as the arms, face, and neck. Atypical burns may occur in unexposed areas such as the buttocks. Burns involving entire hands and feet are also not typical, neither are third-degree burns involving a very small, focused area (resembling, for example, a cigarette).


Burns are caused by exposure to thermal, electrical, or chemical sources. Thermal burns occur when hot metals, scalding liquids, steam, or flames come in contact with the skin. Exposure to electrical current causes electrical burns, and contact with caustic chemicals causes chemical burns. Prolonged exposure to the sun's ultraviolet rays or to other sources of radiation (such as from tanning booths) can also cause burns.

The most serious burns are usually caused by scalding hot or flammable liquids, and fires. Exposure to chemicals and electrical currents also cause severe injury and damage to the skin.

Risk Factors

Preventive Care

The following actions have been shown to lower the incidence of burns: The following steps may help reduce the severity of a burn once it occurs:


When diagnosing a burn, a healthcare practitioner will evaluate the depth and extent of the damage, the degree of pain, the amount of swelling, and signs of infection. They will classify the burn based on the depth and extent of the injury (as described in the Overview section). Burns that cover a significant portion of the body, burns associated with smoke inhalation, burns resulting from electrical injuries, and burns associated with suspected physical abuse are treated as emergencies and require hospitalization. In the emergency room, all wounds are wrapped with sterile towels and patients receive oxygen (either through a mask or tube) and fluids (some patients require intravenous fluids). Patients are also evaluated for associated injuries (such as from physical abuse). Physicians may also conduct a biopsy to determine whether infection is present in the wound.

Treatment Approach

Appropriate treatment for burns depends on the extent of the tissue damage, the cause of the burn, and whether or not infection is present. All burns (with the exception of mild, first-degree burns) require immediate medical attention because of the risk of infection, dehydration, and other potentially serious complications.

The following steps may be taken in an emergency situation:

First-degree burns: Second-degree burns: Third-degree burns: People who have sustained serious burns will be admitted to a hospital where keeping the area clean and removing any dead tissue through a process called debridement are of the utmost importance. Medications will be used to reduce pain and prevent infection. A tetanus shot will be administered if the person has not had one in 5 or more years.

Burns are often accompanied by pain and anxiety, even during recovery. A person may also experience emotional distress if a burn alters his or her appearance. Complementary therapies that may help a person alleviate such pain and anxiety include: Proper nutrition is particularly important during the recovery phase, as certain vitamins and minerals have been shown to promote wound healing and prevent the spread of infection. Many traditional cultures also use herbs to treat burns, although the safety and effectiveness of these remedies are not well understood.


Surgery and Other Procedures

In the case of severe burns, removal of dead tissue, known as debridement, and skin grafting (transplanting a piece of skin from one part of the body to the damaged area) improves the recovery process. Cosmetic surgery may also be necessary to improve both the function and appearance of the burned area.

Nutrition and Dietary Supplements

It is especially important for people who have sustained serious burns to obtain adequate amounts of nutrients in their daily diet. Burn patients in hospitals are often given diets high in calories and protein to speed recovery. When skin is burned, a substantial percentage of micronutrients, such as copper, selenium, and zinc may be lost. This increases the risk for infection, slows the healing process, prolongs the hospital stay, and even increases the risk of death. Although it is unclear which micronutrients are most beneficial for people with burns, many studies suggest that a multivitamin including the following nutrients may aid in the recovery process: In addition, vitamin K levels tend to be low following a burn. However, it is not known whether additional supplementation of this vitamin will help under these circumstances.

Oxidative stress (injury to cells caused by free radicals, which are substances in the blood that result from normal metabolic processes in the body) is believed to contribute significantly to skin and soft tissue damage incurred from a burn. In addition, levels of several antioxidants (substances that protect against the cell damage of free radicals) are measurably lower in burn victims, including beta-carotene, and vitamins A, C, and E. For this reason, antioxidant therapy using, for example, vitamins C and E and carotenoids, is often part of the treatment of burns, particularly soon after the injury takes place. The precise amount and combination to use, however, is not entirely clear. While there is some evidence that vitamins C and E, both taken orally, work particularly well together in preventing sunburn, it is not clear whether this benefit would be the same for treatment of burns of any cause once they have occurred.

In addition, although it is popular during the time of recovery from a burn to use topical vitamin E to try to diminish scar formation, one study found no cosmetic benefit when using topical vitamin E for surgical wounds.

Essential Fatty Acids
Essential fatty acids (fatty acids that the body does not make and must, therefore, be obtained through the diet) have been used to reduce inflammation and promote wound healing in burn victims. Animal research indicates that omega-3 fatty acids (one class of essential fatty acids) help promote a healthy balance of proteins in the body—protein balance is critical to proper organ function and general health, particularly after sustaining a burn. Further research is necessary to determine whether essential fatty acids have similar effects on protein balance in people who have suffered a burn.

Bromelain, a collection of protein-digesting enzymes found in the stem of pineapple plants, has been used historically to reduce swelling following soft tissue damage. Some studies of animals indicate that bromelain (applied topically) may also be useful in removing dead tissue from third-degree burns. This has not yet been tested on humans.


Aloe (Aloe vera)
Aloe has been used for centuries to heal skin lesions and wounds. Aloe contains glycoproteins, protein-carbohydrate compounds that speed the healing process by stopping pain and inflammation, and polysaccharides, a type of carbohydrate that stimulates skin growth and repair. In one study conducted in Thailand in 1995, 27 people admitted to a hospital for first- and second-degree burns had one half of their burn treated with aloe vera gel and the other half treated with petroleum jelly. The area treated with aloe vera healed significantly faster than the area treated with petroleum jelly, although there were some reports of discomfort and brief pain with the aloe vera gel treatments. These results seem encouraging, however, studies comparing aloe vera with standard medication may help determine whether the herb is as effective for the treatment of burns as more customary therapies.

In some traditional medical practices, honey is applied to the skin to prevent infection and heal wounds. Results from two well-designed studies conducted in India suggest that topical applications of honey may heal burns significantly faster than the antimicrobial ointment, silver sulfadiazine. Some researchers attribute this effect to nutrients in honey that promote skin growth and to antibacterial substances present in honey.

Papaya (Carica papaya)
In The Gambia, Africa, papaya is used topically to help remove dead tissue from burn wounds and prevent infection. Although the exact mechanism of action is unclear, researchers suggest that papaya contains enzymes that break down the proteins in dead tissue. In addition, papaya is believed to have antimicrobial properties.

Tea Tree Oil (Melaleuca alternifolia)
In Australia, tea tree oil was used by aborigines and early settlers to treat burns. Some reports suggest that the herb may prevent the spread of infection. Modern studies, however, have not confirmed this function for tea tree oil. In fact, a recent study suggests that substances in tea tree oil may even be destructive to skin cells and may actually slow the healing process. Therefore, until more is known about the value of tea tree oil for burns, it is best to avoid use of the herb for this purpose.

Other Herbs Although some herbs used historically have not been researched scientifically, they may be considered by an herbal specialist to treat first-degree burns. Each of the following remedies would be applied topically.


Electrical Stimulation
Transcutaneous electrical nerve stimulation (TENS) is a method of applying controlled, low-voltage electrical stimulation to the skin for the purpose of relieving pain. Recent studies have suggested that TENS applied to acupuncture points (called electroacupuncture) on the ear (auricular acupuncture) may provide pain relief for people with burns. In one study, 11 burn patients received two forms of treatment prior to wound care: auricular TENS and a placebo pill. Seven patients reported at least a 70% reduction in pain during the TENS acupuncture treatments and only two patients reported that degree of relief when receiving the placebo pill. This preliminary study suggests that further investigation into the use of auricular electroacupuncture for the relief of pain in burn patients is warranted.

Massage and Physical Therapy

Massage Therapy
People with burns suffer pain, itching, and anxiety both from the burn itself and during the healing of the wound. Some studies suggest that massage may help ease these symptoms in both the emergency-care and recovery phases. In one study, 28 burn patients were randomly assigned to receive massage therapy or standard treatment while in the hospital. Patients in the massage therapy group received a 20-minute general body massage prior to wound cleaning once a day for 1 week. Reported effects included: In another small study, 20 burn victims were randomly assigned to receive massage and standard therapy or standard therapy only during the recovery phase of their injury (between 80 to 165 days after the injury). The massage group received a 30-minute massage twice a week for 5 weeks in addition to standard therapy (consisting of physical and occupational therapy, regular check ups by the physician, medication for symptoms of pain and itching, and application of cocoa butter to the closed wound). People who received massages reported significantly less itching, pain, anxiety, and depressed mood compared to those who received standard care only.

Physical Therapy
Occupational and physical therapy begin very early for patients who are hospitalized for burns. The techniques used by occupational and physical therapists improve movement and function and reduce scar formation. Rehabilitation with the guidance of occupational and physical therapists may include the practices listed below: Homeopathy
Although very few studies have examined the effectiveness of specific homeopathic therapies in the treatment of burns, professional homeopaths may consider the following measures to treat first and second degree burns and to aid recovery from any burn. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Mind/Body Medicine

Several studies suggest that hypnosis may reduce pain and anxiety and enhance relaxation in burn patients. In one study, 30 hospitalized burn patients received either standard wound care (including pain medications) or standard wound care plus hypnosis with a technique called rapid induction analgesia (RIA). RIA sessions were administered prior to wound care over four burn care sessions during a 48-hour period. Patients who received RIA treatment had less anxiety and pain as well as reduced consumption of pain medication over the course of the burn care sessions. Relaxation ratings also increased in the RIA group during this time. These findings suggest that RIA may be a helpful addition to standard wound care in burn patients; further research of hypnosis is certainly warranted.

Therapeutic Touch
Therapeutic touch (TT) is based on the theory that the body, mind, and emotions form a complex energy field. Therapists seek to correct the body's imbalances by moving their hands just over the body in a practice they call "the laying on of hands." This practice has been used for a variety of ailments including the relief of pain and anxiety, but studies have shown conflicting results. A recent trial of patients hospitalized for severe burns suggests that TT may reduce pain and anxiety associated with burns. Ninety-nine patients received either TT treatments or sham TT treatments (therapists moved their hands over the body but did not attempt to alter the energy field) once a day for 5 days. Patients who received TT treatments reported a significant reduction in pain and anxiety compared with the sham group, but there was no difference between groups in amount of medication used, stress relief, or satisfaction with therapy.

Other Considerations

Prognosis and Complications First-degree burns generally heal on their own in 10 to 20 days if no infection develops. In rare cases, first-degree burns spread more deeply to become second degree (this spread is caused by infection). Third-degree burns often require a skin graft


Alexander. Influence of EPA and DHA intravenous fat emulsions on nitrogen retention. Nutrition. 1999;15(2):161-162.

Ampicillin. NMIHI. Accessed at http://www.nmihi.com/a/ampicillin.html on October 9, 2018.

Antoon AY, Donovan DK. Burn Injuries. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, Pa: W.B. Saunders Company; 2000:287-294.

Azithromycin. NMIHI. Accessed at http://www.nmihi.com/a/azithromycin.html on October 9, 2018.

Baumann L, Spencer J. The effects of topical vitamin E on the cosmetic appearance of scars. Dermatol Surg. 1999;25:311-315.

Berger M, 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.

Burns. NMIHI. Accessed at http://www.nmihi.com/b/burns.htm on October 9, 2018.

Burns. MedlinePlus. Accessed at https://medlineplus.gov/ on October 9, 2018.

Burns. Diagnosis and treatment. MFMER. Accessed at https://www.mayoclinic.org/ on October 9, 2018.

Ciprofloxacin. NMIHI. Accessed at http://www.nmihi.com/c/ciprofloxacin.html on October 9, 2018.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 295.

De-Souza DA, Greene LJ. Pharmacological nutrition after burn injury. J Nutr. 1998;128:797-803.

Faoagali J, George N, Leditschke JF. Does tea tree oil have a place in the topical treatment of burns? Burns. 1997;23(4):349-351.

Field T, Peck M, Hernandez-Reif M, Krugman S, Burman I, Ozment-Schenck L. Postburn itching, pain, and psychological symptoms are reduced with massage therapy. J Burn Care Rehabil. 2000;21:189-193.

Field T, Peck M, Krugman S, et al. Burn injuries benefit from massage therapy. J Burn Care Rehabil. 1998;19(3):241-244.

Gilboa D, Boenstein A, Seidman DS, Tsur H. Burn patients' use of autohypnosis: making a painful experience bearable. Burns. 1990;16(6):441-444.

Hayashi N, Tsuguhiko T, Yamamori H, et al. Effect of intravenous w-6 and w-3 fat emulsions on nitrogen retention and protein kinetics in burned rats. Nutrition. 1999;15(2):135-139.

Jenkins ME, Gottschlich MM, Kopcha R, Khoury J, Warden GD. A prospective analysis of serum vitamin K in severely burned pediatric patients. J Burn Care Rehabil.1998;19(1 Pt 1):75-81; discussion 73-74.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctor's Guide. New York, NY: Warner Books;1996:143-145.

Lewis SM, Clelland JA, Knowles CJ, Jackson JR, Dimick AR. Effects of auricular acupuncture-like transcutaneous electric nerve stimulation on pain levels following wound care in patients with burns: a pilot study. J Burn Care Rehabil. 1990;11:322-329.

Levofloxacin. NMIHI. Accessed at http://www.nmihi.com/l/levofloxacin.html on October 9, 2018.

Madoff L. Infections from bites, scratches, and burns. In: Fauci A, Braunwald E, Isselbacher KJ et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: The McGraw-Hill Companies, Inc.; 1998:838-839.

Metronidazole. NMIHI. Accessed at http://www.nmihi.com/m/metronidazole.html on October 9, 2018.

Meyer NA, Muller MJ, Herndon DN. Nutrient support of the healing wound. New Horizons. 1994;2(2):202-214.

Patterson DR, Adcock RJ, Bombardier CH. Factors predicting hypnotic analgesia in clinical burn pain. Int J Clin Exp Hypn. 1997;XLV(4):377-395.

Preventing Burns in Your Home. American Academy of Family Physicians Accessed at https://familydoctor.org/ on October 9, 2018.

Somboonwong J, Jariyapongskul A, Thanamittramanee S, Patumraj S. Therapeutic effects of aloe vera on cutaneous microcirculation and wound healing in second degree burn model in rats. J Med Assoc Thai. 2000;83:417-425.

Starley IF, Mohammed P, Schneider G, Bickler SW. The treatment of pediatric burns using topical papaya. Burns. 1999;25:636-639.

Subrahmanyan M. A prospective randomized clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine. Burns. 1998;24:157-161.

Subrahmanyam M. Topical application of honey in treatment of burns. Br J Surg. 1991;78:497-498.

Taussig SJ, Batkin S. Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update. J Ethnopharmacol. 1988;22:191-203.

Turner JG, Clark AJ, Gauthier DK, Williams M. The effect of therapeutic touch on pain and anxiety in burn patients. J Adv Nurs. 1998;28(1):10-20.

Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. Binghamton, NY: Pharmaceutical Products Press; 1994.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995:334.

Visuthikosol V, Sukwanarat Y, Chowchuen B, Sriurairatana S, Boonpucknavig V. Effect of aloe vera gel to healing of burn wound a clinical and histologic study. J Med Assoc Thai. 1995:78(8):402-408.

Wright BR, Drummond PD. Rapid induction analgesia for the alleviation of procedural pain during burn care. Burns. 2000;26:275-282.