Burns and scalds: first aid, treatment, healing time and when to get help

The NHS says you should treat all burns and scalds straight away. St John Ambulance puts it plainly: your priority is to cool the burn as quickly as possible. The steps are the same for most burns.

• Hold the burn or scald under cool running water for 20 minutes, as soon as possible, within 3 hours of it happening (NHS). St John Ambulance says at least 20 minutes or until the pain feels better.

• If there is no running water, use cool bottled water, a wet towel, or cold milk or canned drinks.

• Remove clothing or jewellery near the affected area, but do not remove anything stuck to the burn.

• When the burn has cooled, lay cling film lengthways over it. Do not wrap it around the burn, as the area needs space to swell. A clean plastic bag can be used for a hand or foot.

• Do not use ice, creams, gels, oils or butter. Do not use plasters or sticky dressings, and do not burst any blisters.

• Take painkillers such as paracetamol or ibuprofen for pain.

The NHS says to call 999 or go to A&E if a burn or scald is very large or deep, is on the face, genitals or bottom, or has been caused by an acid or chemical, or by electricity. Do not drive yourself: ask someone to drive you or call 999, and bring any medicines you take. If you are not sure what to do for yourself or a child, call NHS 111, and call 111 for advice for a child under 5.

NICE Clinical Knowledge Summaries lists the burns that need immediate hospital assessment for clinicians. They include all complex burns (all electrical and chemical burns, burns to the face, hands, feet, perineum or genitalia, burns crossing joints, circumferential burns, and thermal burns covering more than 15% of the body in adults or more than 10% in children), all full-thickness burns, any burn with suspected inhalation injury, and any burn associated with suspected non-accidental injury.

The NHS says small burns and scalds can often be treated at home. After first aid, you can take painkillers such as paracetamol or ibuprofen, and use an emollient ointment if the area becomes itchy and dry as it heals; a pharmacist can advise on what to use. Do not put any creams, oils or butter on the burn, do not use plasters or sticky dressings, and do not burst blisters.

Severe burns and scalds that are large or deep may need treatment in hospital. The NHS says this may include antibiotics or painkillers, having the burn cleaned and dressed, fluids given through a vein, and surgery to repair the wound or reconstruct damaged skin. NICE CKS adds that primary care management includes appropriate wound management, simple pain relief, skin care advice, considering tetanus prophylaxis, and assessing for infected wounds.

NICE CKS defines a burn as an injury caused by exposure to thermal (heat), chemical, electrical or radiation energy, and a scald as a burn caused by contact with a hot liquid or steam. The NHS says burns usually happen when dry heat, such as fire or a hot iron, touches the skin, and can also be caused by electricity or chemicals, while scalds are caused by hot liquids or steam.

The severity of a burn is determined by its location, extent and depth, the person's age and the presence of other injuries or conditions. NICE CKS describes burns by depth, including partial-thickness and full-thickness burns, and divides them into non-complex burns that can usually be managed in primary care and complex burns that need hospital assessment.

The NHS says small burns and scalds can take around 2 weeks to heal, and that severe, large or deep burns may need hospital treatment. Healing time depends on the depth and size of the burn and whether it gets infected. Sunburn usually gets better within 7 days, according to the NHS.

Seek advice if the burn is not healing, if there are signs of infection, or if the skin is getting more painful, red or swollen.

The NHS says a scar is a mark on the skin after a wound or injury has healed. You cannot get rid of a scar, but most fade over time, which can take up to 2 years or more. You can help most scars heal and improve how they look by massaging the scar with a water-based cream once the wound is fully healed, keeping it covered when in the sun for at least 1 year, and using sunscreen of SPF 30 or more.

A pharmacist can recommend silicone dressings or gels. A GP may recommend treatments such as steroid injections or cream, cryotherapy, laser therapy or skin camouflage, or refer you to a specialist, and can refer you for talking therapy if a scar is affecting your mental health. See a GP if a scar is painful or bothering you, and get urgent advice if a scar is swollen or painful, feels warm, or has pus coming out of it.

The NHS says to call 111 if you need advice for a child under 5 years old with a burn or scald, and that children should be cooled in the same way, with cool running water for 20 minutes. NICE CKS sets lower thresholds for children, classing a thermal burn covering more than 10% of the body (more than 5% in children younger than one year) as complex, and says all deep dermal burns in children need immediate A&E admission.

Take care that a baby or young child does not get too cold while being cooled, as the NHS advises for sunburn. For sunburn, the NHS says to get urgent advice if a baby or young child has sunburn, or if skin is blistered or swollen.

Most small burns are managed by a pharmacist, GP practice or minor injuries unit. Larger, deeper or complex burns are assessed in A&E and referred to specialist burns services, which provide dressings, surgery such as skin grafting and rehabilitation. Ongoing scar care and psychological support are available through your GP.

Some people choose private dermatology or scar treatment later on. The assessment and options are the same, and a GP can be kept informed of any plan.