On this page
Burns
Scalds, flame burns and hot oil burns are common hand injuries that can significantly affect hand function and quality of life.
This page covers first aid, dressings and pain management, and explains when surgery may be needed.
What is it?
A hand burn is an injury to the skin, and sometimes the deeper tissue, of the hand caused by heat, such as a scald, a flame burn or a hot oil burn. Early and appropriate management is important in achieving the best outcome, because hand burns can significantly affect functional capacity and quality of life.
At a glance
What is it?
An injury to the skin of the hand caused by heat, such as a scald, flame or hot oil burn
Common symptoms
Pain, redness, blistering and swelling of the affected hand
Who it affects
Anyone – scalds, flame burns and hot oil burns are the most common causes
Is it serious?
Superficial burns usually heal in 1 to 3 weeks without surgery; deeper burns may need surgery and experienced hand burn care
Treatment options
First aid, dressings and wound care, hand therapy, and surgery for deeper burns
First step
Cool the burn under running water for 20 minutes, cover it, and seek medical care
Common causes of hand burns
- Scalds from hot liquids
- Flame burns
- Hot oil burns
The depth of a burn determines its severity. Superficial burns usually heal within 1 to 3 weeks and do not require surgery, but deeper burns may require surgery and are best assessed early.
Immediate first aid
The first thing to do when you or someone close to you sustains a burn is to give first aid: hold the burned area under cool (not cold) running water for 20 minutes, or until the pain subsides. If this isn’t possible, immerse the area in cool water or apply cool, damp compresses. Remove any jewellery or burned clothing, and don’t apply ice.
Once the burn is cooled, cover it with a non-stick dressing. Cling film (plastic wrap) is a good option, as it keeps the area clean and can be removed easily so it can be examined when you reach medical care. Avoid dressings that shed lint or material into the wound – wrapping the area is protective and reduces pain, as burned skin is more painful when exposed to air.
Then seek medical care, from your GP, an urgent care centre or an emergency department.
Will I need surgery?
Most burns will not require surgery, especially with appropriate dressings and wound care started early. The depth of the burn determines its severity: superficial burns usually heal within 1 to 3 weeks without surgery, while deep burns may require surgery.
The Australian and New Zealand Burn Association’s referral criteria include hand burns among the injuries suitable for referral to a specialised burns unit. Not every hand burn needs management in a dedicated burns unit, but it is best to have hand burn dressings directed by a clinician experienced in treating hand burns.
Pain relief, antibiotics and dressings
Keeping your hand elevated above the level of your heart reduces swelling and throbbing pain, and keeping the burn covered with a dressing also helps. Take pain medication at least 30 minutes before each dressing change; regular paracetamol and/or ibuprofen are usually safe and appropriate choices. As with all medications, use only as directed and consult your health care practitioner if pain or symptoms persist.
Antibiotics are not routinely recommended for burns, but are prescribed if an infection develops. Watch for increasing constant pain, redness, fever, swelling or a foul smell, and seek further medical care if these occur. A tetanus booster is recommended if you are not up to date.
Dressings are applied to prevent infection, reduce water and heat loss, and promote healing. Burned fingers are dressed individually with the minimal amount of material, so the fingers can keep moving, which helps prevent stiffness. Dressing type and change frequency vary; dressings impregnated with silver are particularly useful for their antibacterial effect. Small blisters are usually left intact, but large blisters (bigger than a 50 cent piece) or those over a joint may be opened when a dressing is applied. Blister fluid that looks “gluggy” is normal and is not a sign of infection.
Seeing a hand therapist early for a splint that holds your hand in the optimal position, and facilitates use of any digits that do not need to be immobilised, is strongly recommended.
Hand therapy and recovery
Early hand therapy improves outcomes in hand burns. Swelling is managed through elevation, movement and pressure, which reduces stiffness and helps restore movement. Spreading your fingers apart and drawing them together helps reduce swelling; if your burns are superficial, making a full fist and straightening your fingers is also a good exercise. If your burns are deeper you may be advised to avoid making a full fist initially.
An elastic wrap can apply gentle pressure to the fingers and hand and help keep dressings in place. Deeper burns may require splinting and other specific therapies.
Burned skin often heals with pigment changes, so the area may look darker or lighter than the surrounding skin, particularly after a deep burn or surgery. The skin remains fragile for months, so avoid friction and sun exposure on the healed area, and use moisturiser and massage. There is a risk of hypertrophic scarring, which depends partly on individual factors and can be reduced with pressure, silicone, massage, and sun avoidance.
Surgery for hand burns
Surgery may be needed to debride (clean) a burn, particularly if it becomes infected. Skin grafts are sometimes required for deep burns, where there are insufficient skin cells left for the wound to heal within 2 to 3 weeks. Prompt excision and grafting of burn wounds results in less hypertrophic scarring, fewer contractures and improved outcomes.
Burns to the palm (where the skin is thick and sensation is very important) are rarely treated with skin grafts, except in very deep burns. Skin grafts are more commonly needed on the back of the hand.