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About Burns

Burns occur when a person comes in contact with fire or a hot liquid, causing damage to the layers of the skin and pain. The severity, or how bad a burn injury is, depends on the temperature of the burning substance or surface and the duration of contact with the skin.

Common Causes of Burns

Fire and flame injuries are most common causes, followed by scalds, contact with a hot object, and electrical injuries. The vast majority of burn injuries happen in the home, and can be caused by many things, including dry or wet heat, chemicals, heated objects, electricity or friction.

Scald burns comprise 35 percent of overall injuries admitted to burn centers in the United States. More than 60 percent involve children five years old and younger. These burns are typically a result of exposure to hot tap water or food and beverages heated on a stove or in a microwave. They are extremely painful and potentially life-threatening.

Each year, the UC San Diego Health Regional Burn Center admits approximately 450 patients, from infants to adults, and treats hundreds more as outpatients.

Understanding Skin

To understand different kinds of burns, it is helpful to know about skin.

The skin is the largest organ of the body. The average adult has 18 square feet of skin, which accounts for 16 percent of total body weight.

Your skin:

  • Acts as a physical barrier for you to the outside world
  • Protects you against infection and injury
  • Provides a water-tight barrier
  • Helps regulate body temperature
  • Contains glands that lubricate and moisturize your skin
  • Undergoes constant repair and regeneration

Lacerations, abrasions or burns alter the skin's ability to protect and buffer you from your surroundings.

Anatomy of the Skin

Anatomy of the skin illustration

The epidermis is the thin top layer of the skin.

The dermis is the thicker underlayer. It contains the sweat glands, hair follicles and nerve endings that feel pain.

The subcutaneous tissue (or hypodermis) is the next layer. This fat layer helps the body to maintain temperature. Underneath the subcutaneous layer is muscle and bone.

Types of Burns

First-Degree or Superficial Burns

A first-degree burn is damage to the first or outer layer of skin (epidermis). It is pink, red, dry and painful, but generally mild. An example of a first-degree burn is a sunburn. If the burn is kept clean and moist, it will usually heal over a week or two. Some peeling will occur and there is no scarring.

Second-Degree or Partial-Thickness Burns

2nd degree burn

A second-degree burn affects a deeper layer of the skin. There is damage to the top layer or epidermis and some damage to the second layer of skin or dermis. There are blisters, which may be broken or intact, and swelling. The skin under the blisters is wet, weepy, pink and painful. This type of burn may occur from a scald, hot grease or contact with a hot surface, such as a curling iron.

Second-degree burns are divided into two categories based upon the depth of the burn:

  1. Superficial second-degree burns typically heal with conservative care (no surgery required) in one to three weeks. Topical medications are placed on the burn wound. Daily wound bandage changes are the norm. New epidermis grows in one to three weeks with proper wound care.
  2. Deep second-degree burns appear more pale than pink. The skin is drier and the sensation of that skin can be diminished. Sometimes, these burns will need surgery for skin grafting. This decision cannot be made in the first few days, and a short course of conservative treatment (topical medications) will be tried to allow wounds to heal, if possible.

Third-Degree or Full-Thickness Burns

In a third-degree burn, all layers of the skin are destroyed. Blisters may be present and color of the skin varies (red, pale pink, white and tan). Typically, these burns have very diminished pain. If a burn DOES NOT hurt, it may be a third-degree burn. These burns usually require surgery for skin grafting.

Initial Treatment for Small Burns in the First 48 Hours

Ice is not recommended as an initial treatment for burns because it can decrease circulation and make the burn worse. Soaking the burn in cool water is fine. Do not put any food-based products on the burn as this may cause infection and make it more difficult to clean the wound. Clean the wound daily with mild soap and water. This can usually be done in the shower or bath. Treat small burns with over-the-counter topical antibiotic ointment, like Polysporin or Neosporin, until healed. Keep the wound covered with a bandage. Burns heal better in a moist, covered environment.

When to Seek Burn Treatment at UC San Diego Health

Seek treatment from the UC San Diego Health Regional Burn Center if the burn is third-degree; goes over a joint; goes all the way around a limb, finger or toe (circumferential); can't be easily bandaged; or if pain is out of control.

We also provide comprehensive rehabilitation services for people who have sustained serious burns. The goal of the therapy for burn injury recovery is to return you to the highest possible functional level of independence. A physical or occupational therapist, or both, will work with you through the complete recovery phase during your hospital stay. You may need to attend outpatient therapy sessions after your discharge from the hospital.

Infection will usually not be seen until at least three to four days after a burn injury. The wound could be infected if there is expanding redness around the wound (some redness on the edges of the wound is normal), yellow or green drainage, or if you develop a fever unrelated to other illness.

Most burns that heal within three weeks will not scar with proper sun protection. However, a person's ethnic background or genetic predisposition to scarring will also affect cosmetic appearance and potential for scarring.

Burn Degree How Much Skin is Damaged How It Looks and Feels How It Heals How It Might Happen How To Treat / When to Seek Treatment
1st Part of the first layer (epidermis) Pink, red, dry and painful Some peeling over a week; no scarring Sunburn or steam Topical lotion
2nd Some damage to second layer (dermis) Blisters are present (should not be removed) or blisters may have popped; skin under blisters is usually wet, weepy, pink and painfulNew epidermis grows in 1 to 3 weeks Hot water, tea, coffee, flash fires, soups, hot foods Small burns can be cleaned and treated with topical antibiotic ointment at home. Larger burns may need treatment at the UC San Diego Health Regional Burn Center.
3rd All layers of the skin are destroyed Blisters may be present or not; color varies (red, pale pink, white or tan); low or no painNeeds skin grafting unless very small Grease scalds, electricity, roofing tar, flames, hot coals Seek treatment at the Regional Burn Center

Appointments & Referrals

Regional Burn Center Location

Burn Specialists

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