What is the recommended treatment for a second-degree burn?

From the Guidelines

For a second-degree burn, immediately run cool (not cold) water over the burn for 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. This initial step is crucial in reducing the depth of injury, pain, and edema, and it speeds up the healing process. After cooling, gently clean the area with mild soap and water, then apply an antibiotic ointment like bacitracin or petroleum jelly to keep the wound moist and prevent infection. Some key points to consider when treating second-degree burns include:

• Covering the burn with a sterile, non-stick bandage or gauze, changing it daily
• Taking over-the-counter pain relievers such as ibuprofen (400-600mg every 6 hours) or acetaminophen (500-1000mg every 6 hours) to manage pain and reduce inflammation, as these are well-tolerated and generally recommended for burn pain 1
• Keeping the burn elevated when possible to minimize swelling
• Not breaking blisters as they protect against infection
• Seeking medical attention if the burn is larger than 3 inches, affects the face, hands, feet, genitals, or major joints, or if signs of infection develop (increased pain, redness, swelling, oozing, or fever) It's also important to note that petrolatum, honey, and aloe have been shown to improve healing time in patients with partial-thickness burns, including unroofed blisters, compared to no dressing or various controls 1. Additionally, specialized burn dressings are assumed not to be available in the first aid setting, but their use can be considered in a clinical setting. In cases of severe burns, early administration of intravenous fluid may be necessary, with experts suggesting that adult burn patients with a total burned body surface area of >10% and pediatric burn patients with a total burned body surface area of >10% should receive 20 mL/kg of an intravenous crystalloid solution within the first hour of management 1. However, for second-degree burns, the primary focus should be on cooling, cleaning, and protecting the wound, as well as managing pain and preventing infection.

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 recommended treatment for a second-degree burn includes the use of silver sulfadiazine cream, USP 1% as an adjunct for the prevention and treatment of wound sepsis 2.

• Apply topical antimicrobial drug to prevent infection
• Silver sulfadiazine cream, USP 1% is indicated for second-degree burns Note: This answer only includes information about the treatment of second-degree burns with silver sulfadiazine cream, USP 1% and does not cover other aspects of burn treatment.

From the Research

Treatment Overview

• The treatment of second-degree burns requires consideration of various factors, including burn site, patient age, and burn area 3, 4.
• There is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds, making treatment challenging 3, 4.

Pre-Hospital First Aid

• Pre-hospital first aid is crucial in the treatment of second-degree burns, and a standardized approach is necessary 5.
• The Expert Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition) provides specific recommendations on pre-hospital first aid, including 29 recommendations on pre-hospital first aid and non-surgical treatment 5.

Non-Surgical Treatment

• Non-surgical treatment, such as advanced dressings, can promote a moist environment and protect the wound 6.
• Hydrogels are a class of burn wound dressings that can adhere to tissue, absorb wound exudate, and protect from the environment 7.

Surgical Treatment

• Surgical treatment, such as tangential excision, may be necessary for deep partial-thickness burns 6.
• The Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition) provides specific recommendations on surgical treatment, aiming to form a standardized clinical treatment plan 3.

Infection Prevention and Treatment

• Infection prevention and treatment are critical in the management of second-degree burns 3, 4.
• The Expert Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition) provides specific recommendations on infection prevention and treatment, aiming to form a standardized clinical treatment plan 4.