What actually helps a burn heal: the first 48 hours

Cool running water, clean cloth, no toothpaste and no ice. The decisions made before you reach a hospital shape the scar you live with for years.

Burn care · · 6 min read

A clinician holding a patient's hands

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This note is a working draft and has not been checked by Prof. Papon. Please do not rely on it for treatment decisions — request an appointment instead.

The first twenty minutes

Cool running water, for twenty minutes, as soon as possible. That is the whole of the first instruction, and it is the one most often skipped. Water at ordinary tap temperature carries heat out of the tissue that would otherwise keep burning after the flame or the liquid is gone. A burn is not a single event; it continues for some minutes after contact, and cooling is what stops it.

Twenty minutes is longer than it feels. Most families stop at two or three, decide it has been long enough, and set off for a hospital. If the journey is long, cooling on the way — a wet cloth, re-wetted — is better than nothing.

What not to put on it

No ice. Ice constricts the vessels feeding the injured skin and can deepen the very burn it is meant to treat. No toothpaste, no butter, no oil, no ash, no egg white. These trap heat, introduce infection, and have to be scrubbed off later — which hurts far more than the burn did.

Cover the burn with a clean, dry cloth once cooling is done. Cling film is better still if you have it: it does not stick, it keeps the wound clean, and it lets a doctor see the burn without pulling anything away.

When to go to hospital

Go for any burn on the face, hands, feet or genitals, any burn larger than the palm of the injured person’s hand, any burn that looks white or leathery rather than red, and any burn in a child or an older person. Burns that do not hurt are not mild ones — a painless burn usually means the nerve endings have gone, which is a deep burn.

Bring the person, not a photograph. Depth is difficult to judge in the first day even in a clinic, and a burn that looks superficial in the evening can declare itself overnight.

Why the first day decides the scar

A burn cooled properly and kept clean often heals as a superficial injury with little to show for it. The same burn left to cook, then dressed in something that infects it, converts to a deeper wound that must be grafted — and a graft leaves a scar for life. The difference between those two outcomes is usually decided in the first hour, by whoever is standing there.

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