What is the initial management for a closed flash burn to the lips?

From the Guidelines

The initial management for a closed flash burn to the lips involves covering the affected area with a nonadherent bandage or clean cloth to protect the wound and reduce pain, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This approach is crucial in preventing further injury and promoting a conducive environment for healing.

• Key considerations in managing closed flash burns to the lips include:
  • Avoiding the application of ice directly to the burn, as this can cause further tissue damage
  • Refraining from using home remedies such as butter or toothpaste, which can introduce infection or irritate the burn
  • Keeping the lips hydrated by frequently applying a thin layer of petroleum jelly (such as Vaseline) and increasing fluid intake
  • Monitoring for signs of infection, such as increasing pain, redness, swelling, or discharge, and seeking immediate medical attention if these occur
• It is also important to note that while petroleum jelly can be used to keep the lips moist, its chronic use should be avoided due to the risk of promoting mucosal cell dehydration and secondary infection, as highlighted in the 2015 ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of oral and gastrointestinal mucosal injury 1.
• Additionally, the 2019 British Association of Dermatologists' guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in children and young people provide useful insights into mouth care, including the application of white soft paraffin ointment to the lips and the use of anti-inflammatory oral rinses or sprays containing benzydamine hydrochloride 1.
• However, the most recent and highest quality study, the 2024 American Heart Association and American Red Cross guidelines for first aid 1, takes precedence in guiding the initial management of closed flash burns to the lips.

From the FDA Drug Label

Directions adults and children 2 years of age and older: clean the affected area apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily may be covered with a sterile bandage The initial management for a closed flash burn to the lips is to clean the affected area.

• For adults and children 2 years of age and older, a topical product like bacitracin may be applied, but this is not explicitly stated for burn management in the label. No specific guidance is provided for managing closed flash burns to the lips, the information is about applying the product to an affected area, which may not necessarily be a burn. 2

From the Research

Initial Management for Closed Flash Burn to the Lips

The initial management for a closed flash burn to the lips involves several key considerations:

• Assessment of the burn depth and severity to determine the appropriate treatment approach 3
• Use of topical antimicrobial agents to prevent infection, with silver-containing dressings being a commonly recommended option 4
• Consideration of the clinical scenario, burn-wound depth, and burn severity when selecting a topical antimicrobial agent 4
• Potential use of Aloe vera as a topical treatment to promote wound healing, although its analgesic effects and efficacy with varying burn severity are uncertain 5

Topical Antimicrobial Agents

Topical antimicrobial agents play a crucial role in preventing infection and promoting healing in burn wounds:

• Silver sulfadiazine is a commonly recommended topical antimicrobial agent, particularly in low-resource settings 4
• Other topical antimicrobial agents, such as honey and nanocrystalline silver dressings, may also be effective in promoting wound healing and preventing infection 6, 5
• The choice of topical antimicrobial agent should be based on the individual patient's needs and the specific clinical scenario 4, 3

Wound Healing and Infection Prevention

Effective wound healing and infection prevention are critical components of burn care:

• Topical antimicrobial agents can help to prevent infection and promote wound healing, although the ideal agent for all clinical scenarios has not been identified 4
• Aloe vera has been shown to expedite wound healing in patients with second-degree burns without increasing the risk of infection 5
• Further research is needed to develop more consistent recommendations for the use of topical antimicrobial agents in burn care 4, 7