Hot water is one of the most common causes of severe burn injuries in younger and older patient populations across the United States. Burn and Reconstructive Centers of America’s (BRCA) nationwide care system treats adult and pediatric scald and steam burn injuries using advanced care techniques. These treatments may include debridement, skin substitutes, revolutionary spray-on skin cells, burn excision and reconstructive procedures such as laser scar therapy and contraction release. Comprehensive burn care means our patients are taken care of from the critical and acute phases of care to outpatient, rehabilitative and reconstructive care. No matter the mechanism of burn injury, BRCA’s expertly trained burn care teams are there to help at every phase of care.
What is a steam burn?
A steam burn is a subcategory of scald burn, which is a subcategory of thermal burn. Thermal burns occur when a person comes into direct or indirect contact with hot objects, surfaces, water, fire, etc. These burns are separated into six categories, one of which is scalds. Scald burns are directly related to burns caused by water, such as cooking water, bath water and steam. Though steam is a byproduct of hot water, people often underestimate how hot the steam is and how it can cause severe injury just as quickly as hot water. While the boiling point of water is 212 °F/100°C, the temperature of steam can be around 212°F/100°C when it first begins to form but can reach even higher temperatures depending on the surrounding temperature, altitude and pressure, or if a solute was added, such as salt.
Common mechanisms of steam burns
The most common places to suffer scalds or steam burn injuries are at home and in your car. Some of these mechanisms include:
- Steam irons
- Steam cleaners
- Pressure cookers
- Health vaporizers
- Steam cookers
- Car radiators
Pressure cookers have helped save time cooking dinner for busy households, but, as the saying goes, quick is not always better. These kitchen appliances have recently received a lot of heat for their dangers. Pressure cookers work by highly pressurizing the contents, making them a combustion risk. There have been incidents when the appliance exploded due to the pressure buildup, incurring severe injury to those nearby. Also, steam burns are another hazard that comes with operating pressure cookers. Releasing the pressure when the food is done cooking is a manual task that often exposes fingers and hands to highly pressurized and heated steam. Burns to the hands and fingers are areas of concern for burn experts as these areas are at high risk of extreme pain and function impairments.
Another of the most common steam burn mechanisms is a car radiator. Radiators cool the engine in cars to keep them from overheating. If a car runs out of coolant or the radiator is damaged, the vehicle may begin to overheat. When a car overheats, it stops working, and steam rises under the hood. In these instances, BRCA suggests calling roadside assistance and leaving the maintenance to the professionals. Opening the hood or radiator cap can cause severe steam burns in an instant! In serious cases, scalding hot water may spray from the radiator incurring injury.
Signs and symptoms of steam burns
Like other thermal burns, the signs and symptoms of steam burns depend on the severity of the burn injury. The severity of the injury is determined by:
- The temperature of the steam
- The amount of time you were exposed to the steam
- The percent surface area affected
- The location of the injury
- Age (children and older adults have thin, sensitive skin)
- And certain pre-existing conditions
After coming into contact with hot steam, assess the area for:
- Skin peeling or sloughing
These signs and symptoms may indicate a burn; depending on the severity, medical attention may be required to help heal the damaged skin and tissue. However, steam burns to the eyes or airways (a risk of vaporizers) are considered medical emergencies. If you’ve suffered a steam burn to the airway, you may have trouble breathing or swallowing, shortness of breath, coughing and more. These symptoms may be more severe if you suffer from breathing problems such as asthma or COPD. Additionally, a steam burn to the eyes may cause pain, blurry vision and temporary or permanent vision loss.
Call 911 or seek medical attention immediately if you suffer a steam burn to the eyes or airways.
Severities of steam burns
Much like sunburns, the severity of a steam burn might not be apparent when it first occurs. A study done by Empa in 2018 has proven that steam penetrates the upper layer of skin, known as the epidermis, to the lower layers of skin and tissue. This process causes deeper, more severe burns that may initially appear as a minor burn.
Steam burns are likely to be second- and third-degree burns. Some second-degree burns may appear as second-degree burns but progress to third-degree burns over time. This is important to be aware of and watch out for as higher severities of burns are likely to need medical attention to heal. So, what should you be looking for?
A second-degree steam burn will appear red, wet and swollen, possibly blistering. This severity is painful and affects both the top and second layers of skin, known as the dermis. Depending on the size of the area and whether the burn progresses into a third-degree burn, medical intervention may be necessary. Often, a second-degree burn smaller than the size of the palm of your hand will heal in a week or two.
A third-degree steam burn is noticeably pain-free. The area will appear dry and tight and be devoid of capillary refill (white). Instead of blistering, you may notice skin peeling or skin sloughing. This burn severity affects the skin and underlying tissue and requires medical intervention to help heal. After medical treatment, the burn may take several months to heal.
Another degree of burn—fourth degree—is the most severe in the burn classification. However, suffering fourth-degree steam burns is highly unlikely but possible. Fourth-degree burns involve the skin, tissue, nerves, tendons, muscles and sometimes bone. Fourth-degree burns are considered medical emergencies, and the top priority is restoring blood flow to the peripheral areas to avoid as much tissue death as possible. The outcome of fourth-degree burns can vary.
Those at higher risk of steam burns
Children have a higher risk of burn injuries due to thinner, more sensitive skin. But that’s not the only reason these populations are at a higher risk of burn injuries.
In the pediatric population, scald burns are the number one burn injury they are likely to suffer. Some common mechanisms of pediatric scald burns are:
- Hot drinks (coffee, tea, hot chocolate)
- Boiling water in pots or pans that are within reach
- Ramen noodles
Children are curious and will put their hands on anything they can reach. Irons are a common source of steam and contact burns for children. Ensure hot objects are out of reach of children and always check hot liquids before giving them to your child. Bathwater should not be above 100° F for children, and the water should be tested with your elbow before putting them into the bath.
Older adults with certain comorbidities, such as peripheral neuropathy, are at an increased risk of scald and steam burns due to their loss of feeling, clumsiness or other symptoms of pre-existing conditions. Older adults should not get into bathtubs or showers or soak their feet without first testing the water. If you cannot feel how hot the water is, use a thermometer. Be aware of numb areas and check them daily for wounds.
How to treat steam burns naturally at home
BRCA does not encourage treating burn injuries at home and advises those who have suffered a severe burn injury to seek medical attention to avoid infection or more serious complications.
For minor burns, defined as first-degree burns or a second-degree burn smaller than the palm of your hand:
- Rinse the area with tepid or slightly warm water to stop the burning process
- Once the burning process has stopped, wash the area with gentle soap and tepid water. Do not scrub at the burn but gently pat the area with sterile gauze.
- For first-degree burns, apply a cooling aloe gel or lotion to the area and take an over-the-counter pain reliever as needed.
- For minor second-degree burns, avoid popping the blisters if blisters are present. If the blisters are already popped, clean the area using the steps above. Apply an antibacterial ointment onto a sterile bandage or gauze pad to the wound. Loosely wrap the area to avoid constricting the wound but tight enough that the dressing does not fall off.
After a burn injury, the first step toward treating the injury is to stop the burning process. Cooling the burn with water is a great way to stop the burning process. However, it is best to avoid using cold or chilly water. Once the burning process has been stopped, you may still feel pain or a burning sensation and experience swelling. You may even have the urge to grab an ice cube to put on the burn to numb the area, cool it down or reduce swelling. Avoid putting ice on your burn. A burn injury can disrupt or impair your body’s natural ability to regulate temperature. Like cold water, ice can irritate the burn and cause more damage to the wound bed. Instead, run a towel under tepid water and wring it out so it isn’t soaked. Place the damp towel on the burn for ten-minute increments to reduce swelling and pain.
When to call the doctor
Please seek medical attention if you experience any of the following:
- A second-degree burn on an area larger than the palm of your hand
- A third-degree burn
- A burn on an area that might reduce function (hands, fingers, feet, toes, major joints)
- A burn on your face or genitalia
- A burn to the eyes or airways
- A large blister or multiple blisters
- A blister that does not heal within a week. This may indicate a chronic or non-healing wound
- A blister that interferes with functionality (on the feet or hands)
All wounds or burns are susceptible to bacterial colonization. Some of those bacteria can be good and help heal the wound, but harmful bacteria often colonize the wound and cause complications in the healing process. The simplest way to know if a burn wound may be infected is a change of appearance.
Many surface infections begin with the presence of cellulitis. Cellulitis is a bacterial infection that presents as red, warm, swollen or tender skin around the wounded area. It can also appear as a red streak or a line emanating from the wound. So, the burn wound may look red around the circumference at the beginning of an infection. This redness may grow over time, covering more surface area. In addition, the burn wound may feel warm or radiate heat, and the area around the wound may feel tender or painful to the touch. If this infection progresses, you may begin to smell a foul odor coming from your burn wound or develop a fever.
Other skin and soft tissue infections include graft ghosting, toxic shock syndrome (TSS), sepsis and septic shock, staphylococcal scalded skin syndrome and necrotizing fasciitis or flesh-eating infections. Signs and symptoms of burn and wound infection include:
- Abnormal drainage
- A change in skin or tissue color
- Foul odor
- Pain in the wound and surrounding areas
- Pain in areas away from the wound
- A blister that appears filled with pus (cloudy and firm)
If you experience any of the above, call your doctor or BRCA’s burn information services at (855) 863-9595 for a consultation or to speak with a provider.
Steam burn prevention
Most steam injuries happen in the home when people are cooking or doing household chores. To help prevent scald and steam burn injuries:
- If using a pressure cooker, wear heat-resistant gloves or oven mitts when releasing the steam. If the machine looks damaged or cracked in any way, do not use it.
- Keep irons off the floor and out of reach of children. Do not leave the steam running; only turn it on when actively using it.
- Avoid using health vaporizers. They can be hazardous and incur airway burns. There is little evidence showing health vaporizers make a difference in certain medical conditions. Ask your provider for advice before using.
- Do not attempt to fix motor vehicles if you have no engineering or mechanic experience. Stand to the side without your face directly over the engine when working on vehicles. Wear protective equipment such as eye coverings and gloves.
- Test bath and shower water to ensure it isn’t too hot for children or those who can’t feel it.
- Let hot beverages and meals cool before serving them to children.
- Help children with microwavable foods, such as ramen noodles, to avoid spills.
- Keep pots and parts away from the stove’s edge, turning the handles to the side.
- Do not carry or hold a child when cooking or drinking hot liquids.
Over the last three years, 54% of pediatric burns referred to Burn and Reconstructive Centers of America (BRCA) were thermal scald burns. Ramen noodles are a common mechanism along with coffee, tea or bathwater. Children and older adults are at an increased risk of scald burns due to their skin sensitivity. It is crucial to test bathwater temperatures, help with hot foods and keep hot liquids out of reach to avoid accidents that may result in serious injuries.
Our providers at Burn and Reconstructive Centers of America are available 24 hours a day, seven days a week. If you would like more information, please visit us at www.burncenters.com. If you would like to speak to our bilingual burn information services representatives, please call us at (855) 863-9595.
For more information on thermal burns, please click here.
For information on burn infections, please click here.
For information on burn ointments, please click here.
For patient stories involving scald burns, please see the following links: