Burns vs. Scalds: Critical Differences in Cause, Pattern, Depth, and Treatment

Both are thermal injuries, but etiology and management differ.

Feature	Burn (Dry Heat)	Scald (Wet Heat)
Source	Flame, hot object, radiant heat, electricity, chemical, friction	Hot liquid (water, oil, soup), steam
Typical Pattern	Contact shape, irregular, charring possible	"Splash marks," flow lines, symmetric if immersion
Depth Distribution	All depths common; deep (3rd/4th) frequent with flame/electric	Predominantly superficial/partial (1st/2nd); deep less common
Clothing Effect	May ignite, adhere, worsen injury	Retains heat, prolongs contact — "soak effect"
First Aid	Stop burning; cool 20 min (not ice); cover clean	Remove wet clothing immediately; cool 20 min; cover clean
Special Risks	Inhalation injury (flame); chemical penetration; electrical internal damage	Perineal/genital scalds in kids/elderly → high morbidity

Unified Principles

• Assess %TBSA (Rule of 9s/Lund-Browder).
• Referral criteria: >10% TBSA, face/hands/feet/genitals/joints, 3rd degree, extremes of age, comorbidities.
• Fluid resuscitation (Parkland) for >15–20% TBSA.
• Early excision/grafting for deep burns.

Prevention: water heater ≤120°F, stove guards, smoke alarms, chemical PPE.