What is the recommended care for second-degree burn injury blisters?

From the Guidelines

Second-degree burn blisters should be left intact whenever possible and loosely covered with a clean cloth or nonadherent dry dressing, as this improves healing and reduces pain. According to the most recent guidelines, cooling of burns with running water is an established and beneficial intervention with little risk of harm 1. After cooling, it may be reasonable to apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera and a clean nonadherent dressing to open burn wounds 1. However, for burns with intact blisters, it is recommended to loosely cover the area with a clean cloth or nonadherent dry dressing while awaiting evaluation by a healthcare professional 1.

Some key points to consider in the care of second-degree burn blisters include:

• Cleaning the burn area gently with cool running water for about 10-15 minutes
• Applying an antibiotic ointment, such as bacitracin or polysporin, to the affected area
• Covering the area with a sterile, non-stick dressing like Telfa or a silicone-based dressing, and securing it with gauze or medical tape
• Changing the dressing daily or whenever it becomes wet or soiled
• Taking over-the-counter pain relievers, such as acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6 hours, as needed for pain
• Seeking medical attention if the burn covers a large area, affects the face, hands, feet, genitals, or major joints, or if signs of infection are present, such as increasing pain, redness, swelling, oozing, or fever. The evidence from previous studies also supports leaving burn blisters intact, as it improves healing and reduces pain 1.

From the Research

Second-Degree Burn Injury Blister Care

• The care for second-degree burn injury blisters involves various treatment options, including the use of topical agents and dressings 2, 3, 4, 5, 6.
• A study comparing hyaluronic acid plus silver sulfadiazine vs. silver sulfadiazine alone found that both treatments were effective and well tolerated, with the combination treatment resulting in a significantly more rapid re-epithelialization of burns 2.
• Silver sulfadiazine is an effective antibacterial agent with low toxicity and few side effects, making it a suitable option for topical use in burns 3.
• The use of silver-sulfadiazine-impregnated collagen dressing has been shown to improve wound healing, control infection, and reduce pain in second-degree burns, with minimal complications 4.
• When it comes to treating burn blisters, the decision to debride or leave them intact depends on their size, with larger blisters often being de-roofed and smaller ones left intact 5.
• A comparison of a hydrocolloid dressing and silver sulfadiazine cream in the outpatient management of second-degree burns found that the hydrocolloid dressing resulted in better wound healing, repigmentation, and patient comfort, with fewer dressing changes and less cost 6.

Treatment Options

• Topical agents:
  • Hyaluronic acid plus silver sulfadiazine 2
  • Silver sulfadiazine alone 2, 3
• Dressings:
  • Silver-sulfadiazine-impregnated collagen dressing 4
  • Hydrocolloid dressing 6
  • Conventional dressings 4

Considerations

• Size of the blister: larger blisters may be de-roofed, while smaller ones are left intact 5
• Patient comfort and compliance: hydrocolloid dressings may be more comfortable and easier to use than silver sulfadiazine cream 6
• Cost and ease of use: hydrocolloid dressings may be more cost-effective and require fewer dressing changes than silver sulfadiazine cream 6