What is the treatment for a second-degree burn?

From the Guidelines

The treatment for a second-degree burn involves immediate cooling of the burn with cool (not cold) running water for about 10-15 minutes to stop the burning process and reduce pain, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. After cooling, gently clean the area with mild soap and water, then apply an antibiotic ointment such as bacitracin or petroleum jelly to prevent infection and keep the wound moist.

• Cover the burn with a sterile, non-stick bandage or gauze wrapped loosely to avoid pressure on the burned skin, as suggested by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
• Change the dressing daily or whenever it becomes wet or soiled. For pain management, over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be taken as directed, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Keep the burned area elevated if possible to reduce swelling.
• Do not break blisters as they protect against infection. Second-degree burns damage both the outer layer (epidermis) and part of the underlying layer (dermis) of skin, causing redness, pain, swelling, and blistering. Seek medical attention if the burn is larger than 3 inches in diameter, affects the face, hands, feet, genitals, or major joints, or if signs of infection develop such as increased pain, redness, swelling, oozing, or fever, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.

From the FDA Drug Label

Silver sulfadiazine cream, USP 1% is a topical antimicrobial drug indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second and third degree burns. 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.

The treatment for a second-degree burn includes:

• Cleansing and debridement of the burn wound
• Application of silver sulfadiazine cream, USP 1% under sterile conditions
• Covering the burn area with the cream at all times
• Reapplying the cream once to twice daily to a thickness of approximately one sixteenth of an inch
• Continuing treatment until satisfactory healing has occurred or until the burn site is ready for grafting 2, 2

From the Research

Treatment Overview

• Second-degree burns require careful consideration of various factors, including burn site, patient age, and burn area, for effective treatment 3.
• There is no unified standard for the diagnosis, classification, and treatment of second-degree burn wounds, making it challenging to formulate clinical treatment plans 3, 4.

Nonsurgical Treatment

• Nonsurgical treatment options for second-degree burns include the use of topical antibiotic ointments, such as fundermol and 1% silver sulfadiazine cream, to prevent infection and promote healing 5, 6.
• Studies have shown that fundermol ointment can accelerate burn wound healing compared to 1% silver sulfadiazine cream 5.
• Aloe vera cream has also been found to be effective in treating second-degree burns, with faster re-epithelialization and healing rates compared to silver sulfadiazine cream 6.

Surgical Treatment

• Deep partial-thickness burns may require immediate referral to a burn surgeon for possible early tangential excision 7.
• Surgical treatment options for second-degree burns are discussed in the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), which provides specific recommendations for surgical treatment 3.

Prehospital First Aid

• Prehospital first aid for second-degree burns is crucial in preventing further injury and promoting healing 4.
• The Expert Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition) provides recommendations for prehospital first aid, including cooling the burn, removing clothing and jewelry, and covering the burn with a sterile dressing 4.