Scald Burn: What to Apply, the 4 Burn Levels a Dermatologist Tells Apart, Which Cream, How Many Days to Heal and When to Go to Hospital
A scald burn is a skin injury from hot liquid or steam. It is the most common type of thermal burn at home. Burn depth falls into 4 levels, from red, stinging skin that heals on its own in 3–7 days to deep wounds that need skin-graft surgery, and "what to apply" depends mainly on that depth, not on the brand.
So the question "what should I put on a scald burn?" can only be answered correctly after two things: first aid with running tap water for a full 20 minutes, and working out how deep the burn is. This article covers both steps, along with generic drug names, how often to apply them, how long healing should take, and the signs that a burn should not be treated at home. If the wound is a graze or scrape rather than a heat burn, read Grazes: how to wash them, whether to cover them, and how many days they take to heal instead.
What is a scald burn, and why work out the level before choosing a treatment
Boiling water is about 100 degrees Celsius, and hot cooking oil can reach 160–190 degrees. Heat at this level destroys the outer skin (epidermis) within seconds, and with longer contact it reaches the dermis, the layer that holds hair roots, sweat glands and nerves.
Burn depth tells you three things at once: whether the wound can heal on its own, how many days it will take, and whether it will scar. A shallow burn needs only moisture and protection from friction. A deep burn needs antibacterial treatment, wound care by medical staff, and sometimes surgery. Applying a strong medicine to a shallow burn does not make it heal faster, and applying only aloe vera to a deep burn wastes time that should go to treatment.
The first 20 minutes: first aid before any cream
What you do in the first hour affects burn depth more than any cream. Follow this order.
Stop the cause immediately. Remove clothing soaked in hot water, because fabric holding hot water keeps scalding the skin. If clothing is stuck to the burn, do not pull it off; cut around it instead.
Take off rings, watches and bracelets before the hand or arm swells, which often starts within 30–60 minutes.
Run room-temperature tap water over the burn for 20 minutes. The ideal water temperature is about 15–25 degrees. Cooling with running water still helps even if you start late, up to 3 hours after the scald.
Do not use ice or very cold water. Ice constricts blood vessels, reduces blood flow to the burn, and can make it deeper.
Keep the rest of the body warm, especially in small children with large burns, because they can easily become too cold. Cool only the burn, not the whole body.
Cover the burn loosely with a clean gauze or cling film (plastic food wrap), laid lengthways, not wrapped tightly around an arm or leg.
After the full 20 minutes, assess the burn level and choose a treatment from the sections below.
How to tell how deep a scald burn is
Use these four signs together: the colour of the wound, blisters, pain, and blanching (press gently with a fingertip for 1–2 seconds and see whether the red disappears and how quickly it returns).
Level 1 (superficial burn): red, dry, no blisters, stinging pain; it blanches when pressed and the red returns quickly.
Level 2, superficial (superficial partial-thickness): clear blisters, a pink-red moist base, very painful; it blanches when pressed.
Level 2, deep (deep partial-thickness): the base is red mixed with white patches, less moist, less painful than expected; the colour returns slowly or not at all when pressed.
Level 3 (full-thickness): pale white, yellow, brown or black, hard like leather, not painful because the nerves are destroyed.
A common misunderstanding is that "the more it hurts, the deeper it is." The truth is the opposite: a burn that hurts unusually little after strong heat is usually the deeper one. A scald can look shallower than it really is in the first hour, because its true depth becomes clear over 24–72 hours, so check it again on day 2–3.
Level 1 scald burn: red, stinging skin with no blisters
Appearance: smooth, dry, red skin with no blisters; the stinging is worst in the first 24–72 hours, then the skin peels in thin flakes on days 3–5, like sunburn.
Cause: the heat damages only the upper layer of the epidermis, for example a brief splash of hot water or steam from a pot.
Severity/urgency: low; it heals on its own in 3–7 days without scarring. Skin colour may darken or lighten temporarily in people with darker skin.
When to see a doctor: the burn is wider than about 10 palms, it is on the face of a small child, or blisters appear on day 2–3, which means the burn is deeper than first judged.
Level 2 superficial scald burn: clear blisters and a lot of pain
Appearance: clear blisters form within a few hours; under the blister is a pink-red, moist base that weeps fluid and hurts a lot when touched by air or rubbed.
Cause: the heat reaches the upper dermis, for example from boiling water spilled on the skin or a few seconds in very hot water.
Severity/urgency: moderate; a small burn can be managed at home. It usually heals in 10–14 days and should not take more than 3 weeks. Most do not leave a raised scar, but they often leave dark or pale marks that fade gradually over 3–12 months.
When to see a doctor: the total burn is bigger than 1 palm, it is on the face, hands, feet, genitals or a joint crease, the blisters are large and tense or have burst into a wide wound, or after 2 weeks there is still no new skin covering it.
Level 2 deep scald burn: patchy pale base and less pain
Appearance: blisters often burst easily or peel off as a sheet of skin; the base is red mixed with white patches, less moist than the superficial type; it feels more like pressure than stinging, and the colour returns slowly when pressed.
Cause: the heat reaches the lower dermis. It is common with hot oil, thick liquids such as rice porridge or curry that cling to the skin for a long time, and scalds in small children, whose skin is thin.
Severity/urgency: high; if left to heal on its own it usually takes more than 3 weeks, and a burn that takes that long has a very high chance of raised scarring and tight, contracting scars.
When to see a doctor: in every case, within 24 hours. The doctor may use special dressings or refer you to a burn unit to consider skin-graft surgery.
Level 3 scald burn: pale white or hard black skin, no pain
Appearance: cloudy white, yellow, brown or black skin, dry and hard like animal hide, with no blisters, no pain when touched, and no colour change when pressed.
Cause: the heat destroys every skin layer down to the fat beneath, for example falling into very hot water, prolonged contact with hot oil, or burning clothing.
Severity/urgency: very high; this skin cannot regrow on its own. A burn larger than about 2–3 cm usually needs surgery to remove dead tissue and graft skin.
When to see a doctor: immediately. Go to a hospital or emergency room however small the burn is, and do not apply any medicine before going. Cover it with a clean cloth or cling film.
What to apply to a scald burn, by depth
After cooling the burn for the full 20 minutes, choose by level as follows.
Level 1: apply aloe vera gel (aloe vera) without fragrance or alcohol, or a gentle moisturiser, or dexpanthenol 5% cream, 2–3 times a day. An antibiotic is not needed, and the burn does not need to be covered.
Level 2 superficial, smaller than 1 palm: rinse gently with clean water or normal saline (0.9% sodium chloride), then apply a thin layer of petroleum jelly (petrolatum) or an ointment recommended by a doctor or pharmacist, and cover with a non-adherent dressing or a hydrocolloid dressing.
Level 2 superficial on the face: chloramphenicol 1% ointment is commonly used in Thai hospitals for facial burns because it can be applied to an uncovered wound. Use it 3–4 times a day as the doctor prescribes.
Level 2 deep and Level 3: do not apply anything yourself before seeing a doctor. The doctor may use silver sulfadiazine 1% cream, silver dressings or other dressings depending on depth, and will schedule regular wound checks.
What should not go on a Level 2 burn: oils, thick perfumed creams and medicated balms, because they trap heat, irritate the open wound and raise the chance of infection.
Each scald burn medicine: how to use it, how many times, and for how long
Aloe vera and dexpanthenol 5%: for Level 1 and newly healed skin. Apply 2–3 times a day until the stinging settles, usually about 5–7 days. They help with moisture and comfort; they do not kill germs.
Petroleum jelly: apply thinly enough to keep the burn moist throughout, 2–3 times a day or at every gauze change. Use it until new skin has fully closed the wound, about 10–14 days for a superficial Level 2. Moisture lets new skin creep across the wound faster than a wound left to form a dry scab.
Chloramphenicol 1% ointment: for burns on the face and ears, 3–4 times a day for about 7–14 days or until the skin closes. A possible side effect is a contact allergy rash; if redness and itching get worse after applying, stop and go back to the doctor.
Silver sulfadiazine 1% cream: for deep Level 2 burns or burns at risk of infection. Apply about 1–2 mm thick, 1–2 times a day, washing off the old cream before each new application. Do not use it in people allergic to sulfa drugs, in women close to delivery, or in babies younger than 2 months. It is not preferred on the face, and studies have found that on shallow burns it may heal more slowly than modern dressings, so it is not the first choice for small scalds at home.
Mupirocin 2% or fusidic acid 2%: used when a doctor has diagnosed a bacterial skin infection of the burn. Apply 3 times a day for about 7–10 days. Do not use it for a long time as prevention, because that raises the chance of resistant germs and allergic rash.
Hydrocolloid: for small, uninfected superficial Level 2 burns. Leave it on for 3–5 days and change it when the dressing swells and turns white or fluid leaks out of the edges. Do not use it on burns with pus or on deep burns.
The final choice of medicine, how often to use it and for how long is a decision for the doctor who has examined the burn. The information above is to help you understand what each one is for.
Scald blisters: can you pop them?
Do not pop them yourself. The skin of a blister works like a natural dressing, keeping germs out and reducing pain. Leave small blisters, no more than about 1–2 cm, and cover them with gauze to protect against friction. A blister that is large, tense, on a joint crease or palm so that you cannot move it, or one that has burst and left hanging skin, should be handled by a doctor or nurse with sterile instruments. If a blister bursts at home, wash it with clean water, apply petroleum jelly, and cover with gauze. Do not pull off any skin that is still attached.
Cover or leave open, and how often to change the gauze
A Level 1 burn does not need to be covered. A Level 2 burn that can be managed at home should be covered to keep it moist and to stop it rubbing on clothing. Change the gauze every 1–2 days, or sooner when fluid soaks through. If the gauze is stuck to the burn, soak it with saline or clean water for 2–3 minutes before peeling it off.
At every change, check three things: is the burn getting smaller, is shiny pink new skin growing from the edges or as islands in the middle, and is there any smell or pus. If the burn is still not getting smaller after day 10–14, see a doctor.
What not to put on a scald burn: toothpaste, fish sauce, egg white, balm, ice
These beliefs are still common, and every one of them can make the burn worse.
Toothpaste: the cooling feeling comes from menthol and does not reduce the heat in the skin, while a thick layer traps heat. Ingredients in toothpaste irritate an open wound, and a doctor has to scrub it off before assessing the burn.
Fish sauce and soy sauce: concentrated salt draws fluid out of injured tissue, stings more, and is not clean.
Egg white: risk of Salmonella and other bacteria getting into an open wound.
Balm, coconut oil, butter: oils trap heat, and some contain camphor or menthol that irritates the burn.
Ice or very cold water: constricts blood vessels, makes the burn deeper, and on a large burn can make the body too cold.
Powdered or crushed tablets sprinkled on the burn: they clump with the wound fluid, are hard to wash off and infect easily.
If you have already applied any of these, rinse them off with gently running tap water and start the first aid again.
Oral medicines for scald burn pain and stinging
The stinging is usually worst in the first 24–48 hours. Adults with no underlying illness can use these common medicines.
Paracetamol 500–1,000 mg every 4–6 hours when in pain, no more than 4,000 mg a day. People who drink alcohol regularly or have liver disease should take less than this. In children, use 10–15 mg/kg per dose.
Ibuprofen 200–400 mg every 6–8 hours after food. Avoid it if you have kidney disease, a stomach ulcer, or are in the last trimester of pregnancy.
As the burn nears healing, around day 7–14, itching is common because the new skin is dry. Apply a fragrance-free moisturiser 2–3 times a day. If it still itches so much that you cannot sleep, a non-drowsy antihistamine such as cetirizine 10 mg once a day can help. For details on each group of antihistamines, read Itch relief: which antihistamine to take. If the pain is so severe that the medicines above do not help, see a doctor, because this is often a sign that the burn is deep or becoming infected.
Scald burns on the face
Appearance: usually caused by steam or hot water splashing when lifting a pot lid or boiling water. The face swells more than other areas on days 1–2, especially around the eyes and lips.
Cause: facial skin is thin and has many blood vessels, so it swells fast, but it also heals faster than other areas.
Severity/urgency: moderate to high; the dark marks after healing are obvious and the skin is more at risk of darkening from sun than other areas.
When to see a doctor: a Level 2 or higher burn on the face should always be seen by a doctor, and go to hospital immediately if there are burned nose hairs or eyebrows, a hoarse voice, coughing up soot, or difficulty breathing, because there may be an airway injury. Also go if hot water has got into the eye and the eye is red or vision is blurred.
Scald burns on the hands, fingers and joint creases
Appearance: the hand is the most commonly scalded site, from lifting pots, pouring hot water or making coffee. Blisters on the back of the hand and between the fingers burst easily with use.
Cause: the skin on the back of the hand is thin, and the finger joints bend and straighten all day, so the burn is pulled and rubbed more than other areas.
Severity/urgency: higher than its size suggests; a burn that heals slowly over a joint crease or between the fingers can become a tight, contracting scar (contracture), so that you cannot fully make a fist or straighten the fingers.
When to see a doctor: a Level 2 or higher burn on the hand, fingers, feet, joint creases or genitals should be seen by a doctor within 24 hours, even if it is small. In the meantime, raise the hand above heart level to reduce swelling, and move the fingers gently several times a day so the joints do not stiffen.
Scald burns in small children and older adults
Appearance: children aged 1–4 often get scalded by pulling a kettle cord, knocking over a cup of hot water, or a bath that is too hot. The burn often follows the line of the liquid running from the chest down the abdomen and arm, while older adults are often scalded in the bath or with a hot compress.
Cause: the skin of children and older adults is thinner than adult skin. Water at 60 degrees can cause a deep burn in a child's skin in about 1 second, while adult skin takes longer, and older adults or people with diabetes who have numb feet often notice late.
Severity/urgency: high; a burn of the same size is deeper, loses more fluid and heals more slowly than in a working-age adult.
When to see a doctor: any Level 2 burn of any size in a baby younger than 1 year; a burn covering more than 5% of body surface (about 5 of the patient's own palms) in a child or older adult; people with diabetes or low immunity; and a child who is drowsy, will not drink, or passes less urine. Prevention that works: keep hot water out of children's reach, turn pan handles inwards, and run cold water before hot when preparing a bath.
How oil, steam, chemical and electrical burns differ from a scald
Hot oil: cooking oil is almost twice as hot as boiling water and clings to the skin for longer, so the burn is usually deeper than a water scald of the same size. First aid is the same: run tap water over it for 20 minutes, but assume it is a deep Level 2 until proven otherwise.
Steam: hot steam from a steamer or rice cooker often causes Level 1–2 burns on the back of the hand and the face. If you have breathed in hot steam and your voice is hoarse or you have difficulty breathing, go to the emergency room.
Chemicals: for example drain cleaner, wet cement or toilet acid. Take off contaminated clothing, then rinse with running water for at least 20–30 minutes. Alkalis such as lime or caustic soda may need longer rinsing. Do not use any other substance to neutralise it, and see a doctor in every case.
Electricity: the skin wound may be only a few millimetres across, but the current can damage muscle and disturb the heart rhythm. Go to hospital in every case, even if you feel normal.
Judging burn size with your palm, and when to go to hospital immediately
The patient's own palm including fingers is about 1% of total body surface. Count how many palms the Level 2 or higher burn covers; do not count areas of Level 1 red skin only.
Go to a hospital or emergency room immediately if any one of the following applies.
Level 2 or higher burns totalling more than 10% in an adult, or more than 5% in a child or older adult
A Level 3 burn of any size
A burn on the face, hands, feet, genitals, perineum or a large joint
A burn that wraps all the way around an arm, leg, finger or the trunk, because swelling will constrict blood flow
A chemical or electrical burn, or inhalation of smoke or hot steam
A baby younger than 1 year, a pregnant woman, or anyone with diabetes, heart disease, kidney disease or low immunity
About tetanus vaccine: if the burn is deep or dirty and the last booster was more than 5 years ago or you cannot remember, you should have a booster. For a shallow, clean burn, the cut-off is more than 10 years.
Signs that a scald burn is infected
A burn has lost the skin that guards against germs, so it can get infected easily, especially on days 3–7. Watch for these.
Pain gets worse after 48 hours instead of gradually easing
Redness spreading out from the edge of the burn by more than about 2 cm, or red streaks running up the arm or leg
Yellow-green pus, a foul smell, or more and more fluid
A fever of 38 degrees or higher, chills, or unusual tiredness
A burn that looked shallow becomes deeper or wider
If any of these happens, see a doctor the same day. Fast-spreading hot red skin may be cellulitis, a bacterial infection of the tissue that needs oral antibiotics. Read more at What is cellulitis?
How many days does a scald burn take to heal?
How long a burn takes to heal tells you both its depth and its risk of scarring. Use these numbers as a self-check.
Level 1: 3–7 days. The skin peels thinly and heals, with no scar.
Level 2 superficial: 10–14 days, and it should not go past 21 days. Most leave no raised scar, but there is a temporary change in skin colour.
Level 2 deep: more than 21 days if not properly treated, with a high risk of raised scarring.
Level 3: it will not heal on its own in a reasonable time and needs surgery.
The most important number is 21 days. A burn that takes more than 3 weeks to close has a clearly higher chance of raised scarring. If after 2 weeks more than half the burn is still open, see a doctor before you reach that point.
After a scald burn heals: dark marks, red marks and raised scars
This part is a dermatologist's job, and it is the part people tend to neglect once the burn has closed.
Dark marks or darkening (post-inflammatory hyperpigmentation): common in Thai skin after Level 1–2 burns, and usually fades by itself within 3–12 months. The most helpful thing is sun protection: SPF 30 or higher every day for at least 6–12 months, plus an umbrella or clothing cover. If the marks have not faded after 3 months, a doctor may consider a lightening treatment such as hydroquinone 2–4% or azelaic acid 15–20% for a short period, depending on assessment. Read more at Post-inflammatory hyperpigmentation (PIH): causes and how to fade it
Pale or white marks: these occur when the pigment-producing cells are injured. Most gradually return within 6–12 months. If the burn was deep, the paleness may be permanent.
Raised scars (hypertrophic scar): they start to rise, turn red and itch in months 1–3 after the burn closes, especially burns that took longer than 21 days to heal. Prevention is to start silicone gel or silicone sheets as soon as the skin has fully closed, using them 12–24 hours a day continuously for at least 2–3 months, together with gentle massage of the scar 2–3 times a day. If the scar has already become thick, the doctor may inject the steroid triamcinolone into the scar every 4–6 weeks, and in some cases consider fractional laser or vascular laser as well to reduce thickness and redness. Results differ from person to person and usually need several sessions; assessment and treatment must be done by a doctor. For choosing a scar cream, read Scar creams: which to choose and how long to use them, and for telling a raised scar from a keloid, read Keloid vs hypertrophic scar: what is the difference?
Sunburn: the symptoms resemble Level 1–2 burns, but the cause and some of the care differ. See Sunburn: causes, symptoms and care.
The short version
First aid before anything else: room-temperature tap water running over the burn for 20 minutes. No ice. Remove rings and wet clothing.
Work out the level: red with no blisters (Level 1) · clear blisters and a lot of pain (Level 2 superficial) · patchy pale and less painful (Level 2 deep) · white or black, hard and painless (Level 3).
Level 1: aloe vera or dexpanthenol. Small superficial Level 2: petroleum jelly and a non-adherent gauze dressing. On the face, doctors often use chloramphenicol 1%, while silver sulfadiazine is used only as a doctor prescribes.
Do not put on toothpaste, fish sauce, egg white or balm, and do not pop blisters yourself.
Go to hospital immediately if the burn is over 10% in an adult or 5% in a child or older adult, is on the face, hands, feet or genitals, or is Level 3.
A burn that has not closed within 14 days should be seen by a doctor, before day 21, when the risk of raised scarring rises. After healing, protect from the sun for at least 6 months.
Frequently asked questions about scald burns
What medicine do you put on a burn from hot water?
It depends on the depth. For a red burn with no blisters (Level 1), aloe vera gel without fragrance or dexpanthenol 5% cream 2–3 times a day is enough. For a burn with blisters smaller than 1 palm, rinse with clean water, apply a thin layer of petroleum jelly, and cover with a non-adherent gauze dressing, changed every 1–2 days. Burns on the face, deep burns or large burns should have the medicine chosen by a doctor, for example chloramphenicol 1% for the face or silver sulfadiazine 1% for deep burns. Before any medicine, always run tap water over the burn for 20 minutes first.
Can you shower with a scald burn?
Yes, and you should, to keep the burn clean. Use room-temperature or slightly warm water, not hot, and let it run gently over the burn. Wash the skin around the burn with a mild fragrance-free soap, do not scrub the burn itself, then pat dry with a clean cloth without rubbing. Then apply the medicine and a fresh gauze dressing straight away. What to avoid is soaking in a bath, swimming pool or the sea until the burn has fully closed, which for a superficial Level 2 burn usually takes about 10–14 days. If you are using a hydrocolloid dressing, you can shower over it without taking it off.
How many days does a Level 1 scald burn take to heal?
A Level 1 burn, which is just red, stinging skin with no blisters, usually heals in 3–7 days. The stinging is worst in the first 24–72 hours, then the skin peels in thin flakes on days 3–5 and leaves no scar. Meanwhile, apply aloe vera or a moisturiser 2–3 times a day, and you can take paracetamol for pain. If blisters appear on day 2–3, the burn is deeper, a Level 2, which takes about 10–14 days to heal and must be cared for as an open wound. Any dark marks left after healing usually fade in 3–6 months if you use sun protection consistently.
What should I do for a scald on the hand?
Take off rings, watches and bracelets straight away, before the hand swells, then run room-temperature tap water over the hand for 20 minutes. Do not use ice. Then check the level. If it is only red with no blisters, you can apply aloe vera or a moisturiser. If there are blisters on the back of the hand, fingers or palm, see a doctor within 24 hours even if the burn is small, because a burn on the hand that heals slowly can leave a tight, contracting scar so that you cannot close the fist fully. While waiting to see the doctor, raise the hand above heart level to reduce swelling, and move the fingers gently several times a day.
What do you put on a hot oil burn?
First aid is the same as for a scald: run tap water over it for 20 minutes, no ice, and no fish sauce or toothpaste. But hot cooking oil is about 160–190 degrees, almost twice as hot as boiling water, so the burn is often deeper than it looks. If it is only small red spots with no blisters, you can apply aloe vera or petroleum jelly. If there are blisters, apply petroleum jelly, cover with a non-adherent gauze dressing, and check again on day 2–3. If the base is pale and patchy, unusually less painful, or the burn is wider than 1 palm, see a doctor, because it may be a deep Level 2 burn that needs wound care by a doctor.
What can I use for a compress to ease scald burn pain?
First run room-temperature tap water over the burn for 20 minutes; this still helps if you start late, within 3 hours. After that, if it still stings, you can occasionally apply a clean cloth soaked in plain cool water. Do not put ice or a frozen gel pack directly on it, because that makes the burn deeper. Oral medicines that help are paracetamol 500–1,000 mg every 4–6 hours, no more than 4,000 mg a day, or ibuprofen 200–400 mg after food. If after 48 hours the pain gets worse again, redness spreads, or you have a fever, suspect infection and see a doctor.
Read more skin condition articles at All skin condition articles
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed October 24, 2026
The information in this article is general knowledge, not a diagnosis or an individual prescription. A burn that is deep, large or in a sensitive location must be assessed by a doctor. The choice of medicine, dose and length of treatment is the doctor's decision. Results vary from person to person, and every medicine can have side effects.
Comments