The short answer is: sometimes. When a person suffers a burn injury, the severity of the burn often progresses and worsens for the first few days after the initial injury. This is due to the inflammatory response triggered by the burn. However, with proper first aid and medical treatment, most minor to moderate burns will begin to slowly improve after the initial worsening phase. Severe burns that damage deeper tissues may require surgery and skin grafts to heal properly. Let’s take a more in-depth look at why burn injuries seem to get worse before they get better.
What happens immediately after a burn injury?
Immediately after burning the skin, the wound begins swelling, reddening, and becoming extremely painful. This is due to the damaged skin cells releasing inflammatory mediators and fluids that cause vasodilation (widening of blood vessels) and increased permeability of blood vessels. As a result, fluid leaks out into the surrounding burned tissues, causing inflammation, blistering, and edema (swelling due to fluid buildup).
In addition, blood flow increases to the area, which is why burns appear red. Nerve endings also become exposed or damaged, which causes severe pain. The burned skin may continue releasing fluids for 48 hours or more after the initial injury.
What’s going on beneath the skin’s surface?
While the visible skin damage worsens and blisters, there is also a lot happening deeper in the skin layers and tissue that contributes to the burn severity progressing:
- The inflammation extends deeper into subcutaneous fat and muscle layers.
- Fluid buildup and edema compress blood vessels, cutting off circulation and oxygen to tissues.
- Heat from the burn destroys proteins in cells and blood vessels, causing leakage.
- Toxins released from damaged cells trigger further inflammation.
- Fluids shifting into the burned area can cause dangerous electrolyte imbalances.
This chain reaction of events creates a vicious cycle, where fluid buildup leads to tissue death, which releases more inflammatory chemicals and fluids. As a result, the burn damage spreads progressively deeper and wider for 24-48 hours following the initial injury.
When does a burn start to improve?
If properly treated, most partial-thickness and mid-dermal burns will typically start to slowly improve 2-5 days after the initial injury. Here’s a general timeline of a typical healing process after a minor to moderate burn:
- Days 1-2: Burn continues to worsen and swell, fluid/toxin release peaks.
- Days 3-4: Inflammation gradually decreases, fluid leakage slows, swelling plateaus.
- Days 5-6: New skin cells begin growing at burn edges, swelling goes down.
- Days 7+: Gradual wound closure by scar tissue, burn pain diminishes.
Of course, the timeline depends on factors like the size, depth, location, and cause of the burn. But in general, the progressive worsening subsides after 48-72 hours, and then the burn will slowly begin to heal if no infection develops.
Why do some burns continue to get worse?
Deeper and more severe burns often progressively get worse for longer than a few days. This is because the injured skin and tissue is no longer able to recover or regenerate naturally. Reasons why the worst burn damage may continue after the initial injury include:
- Full-thickness burns destroying the entire depth of skin.
- Ongoing inflammation and fluid shifts leading to electrolyte imbalances.
- Swelling and fluid buildup compressing internal organs.
- Circulation impaired for too long, causing tissue death (necrosis).
- Destruction of skin’s protective barrier increasing infection risk.
- Toxins from necrotic tissue triggering systemic inflammation.
In these severe burns, the damaged tissues cannot heal without help from surgical debridement (removal) and skin grafting. Aggressive fluid resuscitation and nutritional support are also needed to stabilize and recover from critical burn injuries.
Can a burn heal if it is still worsening?
Yes, it is possible for burns to still begin healing even if they appear to be progressing and worsening. As long as the injury has not destroyed the entire thickness of skin, recovery can begin at the margins and layers that are still intact. For example:
- A superficial partial-thickness hand burn may swell badly for 3-4 days before new skin cells start regenerating from hair follicles and sweat glands.
- A deep partial-thickness face burn may worsen with fluid shifts for a week but then slowly fill in with scar tissue closure from the sides.
- A circumferential arm or leg burn may progressively tighten and restrict circulation temporarily before healing relieves the compression.
So even if the overall size and appearance of a burn seems to be getting worse, the healing process can still be underway where viable tissue remains. Aggressive wound care is needed to remove dead tissue so healing can progress.
When should you worry about a worsening burn?
You should be concerned about a burn that shows any of the following warning signs of complications beyond 3-5 days post-injury:
- Increased swelling, pain, heat at wound site
- Expanding redness past initial burn margins
- Any pus or foul-smelling drainage
- Fever, chills, nausea, dizziness
- New numbness, tingling or loss of function
- Fatigue, shortness of breath, fast heart rate
- Low urine output, dark urine color
These could be signs of a developing infection, excessive inflammation, or other issues like electrolyte imbalance. If the burn worsens in these ways or fails to start improving within a week, immediate medical help is needed.
How can worsening of a burn be minimized?
Prompt first aid and optimal burn care can help minimize how much the initial damage progresses and worsens after injury. Here are some tips for limiting worsening of burns:
- Rapid cooling of the burn for 10-15 minutes with cool running water.
- Covering with a sterile non-stick dressing or clean cloth.
- Keeping burned extremities elevated to limit swelling.
- Avoiding breaking blisters or applying ice directly to the skin.
- Seeking medical help quickly if burn >1 inch wide or on critical areas like face, hands, joints.
- Asking doctor about medication to reduce inflammation and pain.
- Careful wound cleaning/debridement and use of topical antibiotics per medical advice.
- Following physician recommendations for fluid intake and nutritional support.
While some worsening is expected with burns, these evidence-based first aid steps and burn treatments can help prevent excess progression of the injury in the initial days.
When should professional medical help be sought?
It’s important to seek professional medical evaluation for:
- Any burn on the face, hands, feet, joints or genital region
- Full thickness burns with white/charred skin
- Partial thickness burns larger than 3 inches (7.5cm) across
- Electrical or chemical burns
- Burns from explosions/flames causing other injuries
- Burns in infants, elderly, or anyone with chronic medical conditions
- Burns with persistent pain or other worrying symptoms developing
Minor burns can often be treated at home with first aid. But deeper, larger, or complicated burns require specialized medical management to avoid complications like infections, scarring, loss of function, and other lasting effects.
When should you get emergency medical help for a burn?
Go directly to the emergency room or call 911/112 for immediate medical transport if the burn victim:
- Has burns covering >10% of total body surface area
- Has signs of respiratory distress like rapid, shallow breathing
- Develops confusion, fainting, or uncontrolled bleeding
- Is showing signs of shock like low blood pressure, rapid heart rate, bluish lips/fingernails
- Has burns from a chemical splash or prolonged electrical contact
- Is a young child or elderly person with extensive burns
Severe burns require hospital-level care and rapid treatment to avoid further health deterioration or complications. Don’t hesitate to go to the ER or call emergency services when major burns strike.
Conclusion
While burn injuries often appear to worsen progressively for the first few days, this is a normal part of the inflammatory healing process. With proper first aid and wound care, most minor to moderate burns will begin to gradually improve after the initial worsening phase ends. However, larger and more severe burns may require surgical treatment like debridement and skin grafts. Seek emergency medical help if a burn fails to start healing within a week or shows signs of complications. With the right care, even burns that appear to get worse before they get better can heal successfully.
