What is the best management for superficial burns?

From the Guidelines

The best management for superficial burns involves immediate cooling of the burn with running water, as established by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This approach helps limit tissue damage and reduces pain.

• Cooling with running water is beneficial with little risk of harm, as suggested by a meta-analysis of observational data 1.
• The optimal duration of cooling may vary, but cooling until pain is relieved may be a practical first aid approach 1. After cooling, gently clean the area with mild soap and water, then apply a thin layer of petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera and a clean nonadherent dressing to open burn wounds, as recommended by the guidelines 1.
• For pain management, over-the-counter medications such as acetaminophen or ibuprofen are typically sufficient, as stated in the guidelines 1.
• Keep the burn elevated when possible to reduce swelling and watch for signs of infection, including increased pain, redness, swelling, warmth, or pus, which would require medical attention.
• Avoid using ice, butter, or other home remedies, as these can worsen tissue damage or introduce infection, and avoid breaking any blisters that form, as they serve as a natural barrier against infection while the skin underneath heals. Most superficial burns heal within 7-10 days without scarring. It is also reasonable to loosely cover a burn that has intact skin or an intact blister with a clean cloth or nonadherent dry dressing while awaiting evaluation by a healthcare professional 1.

From the FDA Drug Label

Prompt institution of appropriate regimens for care of the burned patient is of prime importance and includes the control of shock and pain. The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions. The cream should be applied once to twice daily to a thickness of approximately one sixteenth of an inch. Treatment with silver sulfadiazine cream, USP 1% should be continued until satisfactory healing has occurred or until the burn site is ready for grafting.

The best management for superficial burns includes:

• Prompt care: Control of shock and pain
• Wound cleansing and debridement: Cleanse and debride the burn wounds
• Application of silver sulfadiazine cream: Apply silver sulfadiazine cream, USP 1% under sterile conditions, once to twice daily, to a thickness of approximately one sixteenth of an inch
• Continued treatment: Continue treatment until satisfactory healing has occurred or until the burn site is ready for grafting 2

From the Research

Management of Superficial Burns

• The best management for superficial burns involves simple first-aid techniques with over-the-counter pain relievers, as they only affect the epidermal layer 3.
• The goal for superficial burns is to optimize re-epithelialization, and topical antimicrobial agents can be used to minimize the proliferation of bacteria and other microorganisms 4.
• Silver sulfadiazine is an effective topical antimicrobial agent with low toxicity and few side effects, but its use may be limited by the emergence of resistant Gram-negative bacilli 5.
• Comparative studies have shown that new dressings with and without silver may have better results than silver sulfadiazine for wound healing, and burns treated with dressings without silver are less likely to become infected 6.
• International guidelines recommend the use of silver-containing dressings, including silver sulfadiazine, for the prevention of burn-wound infection, but there is no ideal topical antimicrobial agent that can be recommended for all clinical scenarios 7.

Key Considerations

• Burn depth and percentage of total body surface area involved are key determinants of the need for referral to a burn center 3.
• Prophylactic antibiotics are not indicated for outpatient management of superficial burns and may increase bacterial resistance 3.
• Patient education during primary care visits may be an effective prevention strategy for burn injuries, which are more likely to occur in children and older people 3.