Cutaneous burns

Last reviewed: 7 Nov 2023

Last updated: 08 Jul 2022

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.

The majority of patients will have satisfying outcomes.

Definition

Burns are very common injuries, predominantly to the skin and superficial tissues, caused by heat from hot liquids, flame, or contact with heated objects, electrical current, or chemicals.

History and exam

Key diagnostic factors

erythema
dry and painful burns
wet and painful burns
dry and insensate burns
burns affecting subcutaneous tissue, tendon, or bone
cellulitis
clouded cornea

More key diagnostic factors

Risk factors

young children
age >60 years
male sex

More risk factors

Diagnostic investigations

1st investigations to order

complete blood count
metabolic panel
carboxyhemoglobin
arterial blood gas
fluorescein staining
computed tomography scan of head and spine
wound biopsy culture
wound histology

More 1st investigations to order

Treatment algorithm

ACUTE

suitable for outpatient care

requires inpatient care

Contributors

Authors

Rob Sheridan, MD

Associate Professor of Surgery

Harvard Medical School

Cambridge

Disclosures

RS is an author of a number of references cited in this topic.

Peer reviewers

Ravi Ubriani, MD, FAAD

Assistant Professor of Clinical Dermatology

Columbia University

New York

Disclosures

RU declares that he has no competing interests.

Chris Tedeschi, MD

Assistant Clinical Professor of Medicine

Department of Emergency Medicine

New York-Presbyterian Hospital

New York

Disclosures

CT declares that he has no competing interests.

Chad M. Hivnor, Major, USAF, MC, FS

Chief

Outpatient & Pediatric Dermatology

59th Medical Wing/ SGOMD

Lackland Air Force Base

San Antonio

Disclosures

CMH declares that he has no competing interests.

Dean D. Ad-El, MD

Chairman, Department of Plastic Surgery and Burn Unit

Rabin Medical Center - Beilinson Hospital

Sackler Faculty of Medicine

Tel-Aviv University

Director of Plastic Surgery Services

Schneider Children's Medical Center of Israel

Petach Tikvah

Israel

Disclosures

DDAE participated as one of the moderators in a course in IMCAS, Paris in January 2009.

Differentials
- Rash in children
- Toxic epidermal necrolysis (Stevens-Johnson syndrome)
- Staphylococcal scalded skin syndrome
More Differentials
Guidelines
- International first aid and resuscitation guidelines
- Management of burns in pre-hospital trauma care
More Guidelines
Patient leaflets
Burns
More Patient leaflets
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Cutaneous burns

Summary

Definition

History and exam

Key diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Treatment algorithm

suitable for outpatient care

requires inpatient care

Contributors

Authors

Rob Sheridan, MD

Disclosures

Peer reviewers

Ravi Ubriani, MD, FAAD

Disclosures

Chris Tedeschi, MD

Disclosures

Chad M. Hivnor, Major, USAF, MC, FS

Disclosures

Dean D. Ad-El, MD

Disclosures

Differentials

Guidelines

Patient leaflets

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice