OVERVIEW

What is a scald?

A scald refers to tissue or organ damage caused by heat, including flames, hot liquids, high-temperature gases, and hot metals. It is a common accidental injury in daily life and falls under the category of burns^[1]. However, some heat sources, such as hot water bottles or heating pads, have relatively lower temperatures but can still cause skin scalds if in prolonged contact. These types of scalds are generally referred to as low-temperature scalds^[2].

The elderly, children, individuals with limited mobility, and those with reduced sensation (such as patients with diabetic peripheral neuropathy) are high-risk groups for scalds.

Depending on the severity of the scald, different measures should be taken for treatment.

Are scalds common?

Yes. Scalds are one of the most common accidental injuries among children aged 1–3^[3], though there is no latest authoritative data on the specific incidence rate.

SYMPTOMS

What are the common manifestations of burns?

Burns fall under the category of thermal injuries, and their severity is assessed based on the affected area and depth.

The evaluation of burn area is relatively specialized and varies by gender and age^[1]. It is generally performed by doctors or professionals and will not be detailed here.

Burn depth can be classified into first-degree, superficial second-degree, deep second-degree, and third-degree^[1], with specific manifestations as follows:

• First-degree: Only the superficial layer of the epidermis is damaged. The affected area appears red, dry, and has a burning sensation. It usually heals within 3–7 days without scarring but may leave temporary pigmentation^[1].
• Superficial second-degree: Involves the germinal layer and the papillary dermis. The area is significantly red and swollen, often with blisters containing clear, pale-yellow fluid. If the blister peels off, the wound appears red, moist, and painful. Without infection, it typically heals in 1–2 weeks without scarring but often leaves pigmentation^[1].
• Deep second-degree: Extends below the papillary dermis. Blisters may form, and after rupture, the wound appears slightly moist with alternating red and white areas. Pain sensation is dull. Without infection, healing takes 3–4 weeks, often with scarring^[1].
• Third-degree: Full-thickness skin destruction, possibly extending to muscles or bones. The wound appears waxy white, charred, or blackened, feels leathery, dry, and lacks fluid. Pain sensation is absent. Skin grafting is required for healing^[1].

Which areas are commonly affected by burns?

Exposed areas such as the hands, feet, and face are most prone to burns.

What severe consequences can burns cause?

The severe consequences of burns can be categorized into short-term and long-term effects:

1. Short-term consequences:

   • Hypovolemic shock: Large or deep burns can cause excessive fluid loss. Without timely fluid replacement, hypovolemic shock may occur, manifesting as rapid heart rate, shallow breathing, reduced urine output, extreme thirst, restlessness, and cold extremities^[1].
   • Infection: Improper wound care may lead to local or systemic infection, characterized by fluctuating body temperature, chills, rapid breathing, and necrotic wounds. Severe cases can be life-threatening^[1].

2. Long-term consequences: Deep burns may result in scarring. If scars form on the face, they can affect mental health and cause functional impairments such as incomplete eyelid closure, ear deformities, or mouth distortion. Scars near joints may lead to restricted movement or joint deformities^[3].

CAUSES

What are the common causes of burns?

Burns are very common in daily life. Contact with flames, boiling water, hot oil, steam, hot metal, chemicals, etc., can all cause burns.

Additionally, prolonged use of relatively high-temperature items such as hot water bottles or heating pads may also lead to skin burns^[2].

Who is more prone to burns?

• The elderly, children, and individuals with physical disabilities or limited mobility are high-risk groups for burns^[1].
• People working in high-temperature environments, such as chefs or steelworkers, are frequently exposed to hot oil or metal and thus more susceptible to burns.
• With the rising incidence of diabetes, the number of patients with diabetic peripheral neuropathy has increased. Many diabetics also suffer from circulatory disorders and peripheral neuropathy, leading to reduced limb sensitivity, poor tolerance, and lower heat perception, making them more prone to burns^[4].

DIAGNOSIS

How is a burn diagnosed?

Generally, doctors can make a preliminary diagnosis based on the patient's symptoms and medical history (determining exposure to flames, boiling water, hot oil, steam, hot metal, chemicals, etc.).

Although the condition is not difficult to diagnose, doctors may also order blood tests, blood biochemistry, and blood gas analysis to further assess the patient's overall condition and determine an appropriate treatment plan.

What tests are needed to diagnose a burn?

• Medical history and physical examination: The doctor will inquire about the injury and observe the burn site and severity to make a diagnosis.
• Blood tests: Including a complete blood count (to check for infection or anemia), blood biochemistry (to assess liver function, kidney function, blood sugar, and electrolytes), coagulation function, and blood gas analysis (drawing a small amount of arterial blood to analyze acid-base balance and lung ventilation function). These tests help evaluate the patient's overall condition and guide treatment.

TREATMENT

Which department should I go to for burns?

For emergency treatment of burns, you can visit the emergency department. Follow-up treatment can be conducted in dermatology, burn surgery, or general surgery.

What are the emergency measures for burns?

• Remove the heat source: Take off clothing and items that hinder heat dissipation, but avoid forcibly removing them to prevent skin tearing^[5]. If necessary, use scissors to cut the clothing, with the blade facing upward to avoid injuring the surrounding skin or tissue.
• Cold water rinse: After removing the heat source, rinse or soak the wound with cold water as soon as possible to reduce swelling and relieve pain. However, the effective duration of cold water treatment is relatively short, typically lasting 15–20 minutes, with diminishing effects after 30 minutes^[5]. For infants with extensive burns, monitor their body temperature closely.
• Protect the wound: Do not pop blisters or remove blister skin, as this may expose the wound to infection. Instead, cover it with clean dressings or cloth^[1,5].
• Seek medical attention promptly: Patients with large or deep burns should receive immediate cold treatment before being sent to the hospital for pain relief, fluid replacement, anti-shock therapy, and further treatment^[5].

What are the treatment methods for burns?

General treatment:

For mild burns, clean the wound with 1:1,000 benzalkonium bromide or 1:2,000 chlorhexidine to remove foreign matter. Preserve the blister skin for superficial burns. For large blisters, use a sterile needle to drain the fluid. Remove blister skin for deep burns^[1].

Medication:

• Intravenous fluids: If the patient loses significant body fluids, showing symptoms like pale lips, cold skin, confusion, or low blood pressure, administer intravenous fluids immediately to restore blood volume^[1].
• Burns can cause severe pain, so oral analgesics like ibuprofen or acetaminophen may be used. For severe burns with infection, doctors may prescribe antibiotics after evaluation^[1].

Surgical treatment:

• Debridement: Remove infected or necrotic tissue to facilitate further treatment and promote recovery.
• Skin grafting: Transplant healthy skin from other body parts to the burned area, suitable for severe burns or those requiring cosmetic restoration. Multiple surgeries may be needed for extensive wounds^[1].

Additional treatments may be provided based on complications.

What are the wrong ways to handle burns?

• Ice application: Ice does not protect or heal burn wounds and may cause severe vasoconstriction, worsening tissue damage^[5].
• Folk remedies: Applying toothpaste, egg whites, cooking oil, soy sauce, or sesame paste can introduce bacteria, increase infection risk, and hinder treatment^[5].
• No treatment: Leaving burns untreated may allow the wound to deepen, complicating recovery and treatment^[5].

DIET & LIFESTYLE

What should burn patients pay attention to in their diet?

Patients with larger and deeper burns may experience significantly weakened gastrointestinal function and should temporarily avoid eating. Once gastrointestinal function recovers, they can be given small, frequent liquid meals such as rice soup or egg soup, gradually transitioning to semi-liquid diets^[6].

Patients with mild burns can maintain a balanced diet, eating more fresh vegetables and fruits while appropriately increasing protein intake—such as fish, meat, eggs, milk, and soy products—to promote wound healing.

What should burn patients pay attention to in daily life?

For small, superficial burns, leaving the wound exposed is sufficient to avoid secondary damage from collisions or friction.

If the wound or blisters are large, consult medical staff before covering them with clean dressings or cloth for simple bandaging. Do not apply medication or puncture blisters without professional advice to prevent infection.

If pain worsens, or redness and swelling become noticeable, be alert to possible infection and seek medical attention promptly.

PREVENTION

How to Prevent Burns?

Children, the elderly, people with limited mobility, and diabetics should stay away from areas where burns may occur, such as kitchens, and avoid contact with boiling water, hot oil, etc.

Chemical substances should be stored properly, such as concentrated sulfuric acid. Personnel handling chemicals must strictly follow standard procedures to prevent burns caused by improper operation.

Those working in high-temperature environments should prioritize safety. For example, chefs can wear gloves and sleeves while cooking to reduce the risk of burns.