Knowing how to treat a burn at home and understanding the difference between a first-, second-, and third-degree burn will reduce scarring and speed healing time. Here's what to do, and when a burn requires a doctor's care.

By Isadora Baum
October 12, 2018

You’re transferring that hot kettle of boiling water to your tea mug and bam—the scorching water spills on your arm. Suddenly you’re in a lot of pain, and you start to notice redness and swelling on your skin, the telltale signs of burn.

The scary part of getting a burn is that you risk permanent scarring, infection, and other consequences depending on the type of burn you have. Yet figuring out fast which degree the burn is and then knowing how to treat it can minimize damage. 

If the burn penetrates all layers of the skin, the skin is leathery or charred, the hands, feet, face, or genitals are burned, or if the affected person is a child or elderly, you’ll need to call an ambulance for urgent medical care. But less severe burns can be treated at home. Here's how to know what type of burn you're dealing with, what to do immediately to reduce damage, the recovery time you can expect, and the home remedies that can speed healing. 

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How to treat a first-degree burn

“Burns are classified by degrees of how deeply they have injured the skin,” explains Sonia Batra, MD, dermatologist and co-host of the television show The Doctors. A burn can be differentiated usually just by looking at your skin’s reaction after the burn occurs, says Dr. Batra.

A first-degree burn is a superficial burn that can cause the skin to turn red and swell slightly but does not eventually result in blistering.

Here’s how to treat a first-degree burn. “First-degree burns can typically be taken care of at home by running the affected area under cool (not cold) water and taking acetaminophen or ibuprofen for minor pain,” says Dr. Batra. Do this immediately and keep the area around the burn clean and clear. Cover with a sterile, non-adhesive bandage or cloth and avoid sunlight.

First-degree burns typically heal within 7 to 10 days. To help it heal, never put ice on it; this can actually make it worse. A cool (not cold) compress is a better idea to soothe any lingering pain.

Scarring occurs depending on the depth of the burn, as deeper burns require new tissue formation to restore the skin’s outer seal. While the new tissue formed may not appear to match the surrounding skin in color or texture, "first-degree burns rarely scar since only the top layer of epidermis is affected,” says Dr. Batra.

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How to treat a second-degree burn

A second-degree burn can cause pain and initial swelling, and then blisters, reddening, soreness, and thickening of the skin.

“Second-degree burns can be treated by running the affected area under cool (not cold) water for at least 15 minutes and taking over-the-counter pain meds,” says Dr. Batra. A cool compress can also be used, but again, don't use ice.

As blisters form, do not pop or break the new blisters. These blisters can become infected and lead to further damage and scarring if they are broken or not treated properly.

Here’s how to treat a burn blister. “Any blisters that form should be covered with antibiotic ointment and non-stick dressings that are changed once or twice a day," advises Dr. Batra. "Because second-degree burns can cause open wounds, refrain from using cotton balls or anything that can leave fibers in the affected area and increase the risk of infection."

As it heals, you might want to see a doctor to test for severity and to prescribe antibiotics, just to be on the safe side.

Second-degree burns usually heal in about three weeks, but can vary depending on how deep the burn is, she says. Second-degree burns affect both the epidermis and dermis, and these may scar if the burn is deep enough, says Dr. Batra.

What’s more, people with olive-tone or pigmented skin are more likely to have lasting discoloration after a burn, as inflammation tends to alter pigment production in darker skin types, she explains. The scarring will improve gradually, though. “Remember that all wounds continue to remodel, and scars improve for 6-12 months after the injury,” she says.

Use strict sun protection on the healing site for a month after the burn to help minimize the risk of pigment change. “If the texture remains firm or raised, silicone-based gels or sheeting may help soften the scar,” adds Dr. Batra.

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How to treat a third-degree burn

A third-degree burn is the most severe and deepest of the three types, causing the skin to turn dark brown in color and thicken greatly, sometimes taking on a white, waxy, leathery appearance, explains Dr. Batra.

“Third-degree burns can cause serious wounds and have long-term consequences; as such, if you suspect you have a third-degree burn, call 911 immediately,” warns Dr. Batra. “While awaiting medical attention, raise the injury above your heart and refrain from treating it on your own,” she advises, the latter to avoid an infection.

A third-degree burn can result in shock, so monitor the person's breathing and pulse rate. If you suspect they're going into shock, lay the person flat, elevate their feet while keeping the burned area elevated if possible, and cover the person with a blanket.

“Blankets and radiant warmers are useful to help conserve heat and to lower risk of shock,” says Robert Glatter, MD, an assistant professor of emergency medicine at Northwell Health and attending emergency physician at Lenox Hill Hospital in New York City.

Third-degree burns can vary greatly in healing time due to the severity of the burn, explains Dr. Batra. “Sometimes skin grafting may be required, which is when a piece of unburned skin is surgically removed from elsewhere and then moved to cover the burned area,” she says.

"Other problems caused by a severe third-degree burn can affect deep skin tissue, bones, and organs, which may need to be treated with surgery, physical therapy, or rehabilitation,” she adds.

Unfortunately, third-degree burns will scar. “Third-degree burns affect all layers of skin. Due to the extent of the damage to tissue and nerve endings, these burns will scar,” says Dr. Batra. “As the dead skin cells begin to regenerate, they will often create an area of thickened, red, shiny skin, and a skin graft may be needed to cover the burned area."

When to see a doctor

If there are subsequent signs of infection, like oozing, swelling, or a fever, the best thing to do is check in with your doctor or urgent care facility, rather than relying on burn remedies that can be done at home or waiting it out.

And if the affected person hasn't had a tetanus shot in years, they need to get one. “All burns to the skin are tetanus-prone, and must be treated as such. A tetanus shot is given every 7-10 years,” explains Dr. Glatter.

If the pain worsens, or the burn blister is larger than two inches, you should seek medical attention. "Burns involving more than 20%-25% of the total body surface area require IV fluid resuscitation,” says Dr. Glatter. That's because burns are a thermal injury that can result in fluid loss, and that may lead to dehydration—which can be dangerous, he adds.

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