What are the symptoms and treatment options for a burn injury?

From the Guidelines

For a burn injury, immediately cool the affected area with cool (not cold) running water for at least 20 minutes, as this helps reduce pain and prevent further tissue damage, according to the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The symptoms of a burn injury can vary depending on the severity of the burn, but common symptoms include pain, redness, swelling, and blistering.

• First-degree burns affect only the outer layer of the skin and may cause redness, swelling, and pain.
• Second-degree burns affect both the outer and inner layers of the skin and may cause blisters, redness, swelling, and pain.
• Third-degree burns extend through all layers of the skin and can cause charred, white, or leathery skin, with little or no pain due to nerve damage.

Treatment Options

For minor burns (1st degree or small 2nd degree),

• apply an antibiotic ointment like bacitracin and cover with a sterile gauze bandage,
• take over-the-counter pain relievers such as ibuprofen or acetaminophen as needed for pain 1. It is essential to seek immediate medical attention for large 2nd degree burns, any 3rd degree burns, burns on the face, hands, feet, genitals, or major joints, or if you're unsure about the severity, as these may require specialized treatment, including intravenous fluid resuscitation, surgery, and other interventions 1. Do not apply ice, butter, or oil to burns, as these can worsen the injury.
• Keep the burn area clean and change dressings daily to prevent infection and promote healing.
• Remove any jewelry or tight clothing near the burn site before swelling occurs to prevent constriction and vascular ischemia 1.
• Consider using petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera on small partial-thickness burns being managed at home, as these may improve healing time 1.

From the FDA Drug Label

Uses first aid to help prevent infection and for the temporary relief of pain or discomfort in minor: cuts scrapes burns The symptoms of a burn injury are not explicitly stated in the drug label, but it can be inferred that they may include pain and discomfort.

• Treatment options for minor burns may include the use of bacitracin (TOP) for the temporary relief of pain or discomfort and to help prevent infection 2.

From the Research

Symptoms of Burn Injuries

• Burn injuries can cause minor acute pain, which can be managed with irrigation of the burn area with cool water, acetaminophen, or a nonsteroidal anti-inflammatory drug 3
• Patients with severe burns may experience significant pain, which can be managed with opioids 3
• Burn injuries can also lead to infections, and patients with full-thickness burns, circumferential burns, or burns on the face, hands, feet, genitals, or perineum should be referred to a burn subspecialist 3

Treatment Options for Burn Injuries

• Acetaminophen is the first-line treatment for pain associated with minor burns 3
• Opioids are a mainstay of pain management for patients with severe burns 3
• Silver sulfadiazine is used widely as a topical therapy, and is a standard treatment for partial-thickness burns 3
• Cool running water is an effective method for cooling burn wounds, and can reduce the risk of deep burns and improve wound recovery 4, 5, 6
• Immediate cooling of burns with cool water can prevent a significant percentage of superficial burns from progressing to deep burns 4
• Prophylactic antibiotics are not indicated for most patients with burn injuries 3

First Aid for Burn Injuries

• Cooling the burn with cool water is an important first aid measure, and can reduce the risk of deep burns and improve wound recovery 4, 7, 5, 6
• Removing the causal agent and cooling the burn with cool water can reduce the need for skin grafting and expensive treatment 4
• Tap water may not be readily available in all places, and alternative cooling methods such as tea tree oil products may be recommended 5
• The temperature of the cooling water is important, and water below 24°C may be more effective in reducing skin surface temperature and pain 5