What is the treatment for a 6-year-old with a patch of blanching erythema due to a burn?

From the Guidelines

For a 6-year-old with a patch of blanching erythema due to a burn, immediate treatment should focus on cooling the burn with cool (not cold) running water for 10-20 minutes, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. After cooling, the burn should be covered with a nonadherent bandage or clean cloth to protect the wound and reduce pain, while avoiding heat entrapment until the burn can be assessed by a healthcare professional 1. The following steps can be taken:

• Apply a thin layer of petroleum jelly or an antibiotic ointment like bacitracin to the affected area
• Cover the area with a non-stick sterile dressing
• Change the dressing daily after gentle cleansing with mild soap and water
• Give over-the-counter pain relief such as children's acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) for pain management It is essential to keep the area protected from sun exposure during healing and to seek medical attention immediately if the burn covers a large area, shows signs of infection, or doesn't improve within a few days. Cooling the burn quickly helps limit tissue damage by reducing the heat transfer to deeper skin layers, while keeping the area clean and covered promotes healing and prevents infection, as supported by the 2010 American Heart Association and American Red Cross guidelines for first aid 1 and the management of severe thermal burns in the acute phase in adults and children 1.

From the FDA Drug Label

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. Treatment with silver sulfadiazine cream, USP 1% should be continued until satisfactory healing has occurred or until the burn site is ready for grafting.

The treatment for a 6-year-old with a patch of blanching erythema due to a burn involves:

• Cleansing and debriding the burn wound
• Applying silver sulfadiazine cream, USP 1% under sterile conditions
• Applying 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

From the Research

Treatment of Burn in a 6-year-old with Patch of Blanching Erythema

• The treatment for a 6-year-old with a patch of blanching erythema due to a burn typically involves topical antimicrobial agents to prevent infection and promote healing 3, 4.
• Silver sulfadiazine is a commonly recommended topical antimicrobial agent for burn wounds, especially in low-resource settings 4.
• However, studies have shown that new dressings with and without silver may have better results than silver sulfadiazine for wound healing, and burns treated with dressings without silver are less likely to become infected than burns with silver sulfadiazine 5.
• The frequency of application of silver sulfadiazine has also been studied, with once-daily dressing changes showing no negative impact on wound outcomes and potentially decreasing length-of-stay, pain levels, and hospital-acquired complications 6.
• Other topical antibiotic ointments, such as triple-antibiotic petrolatum-based ointment, have also been shown to enhance reepithelialization and reduce scar depth and contraction compared to silver-based foam dressings 7.

Topical Antimicrobial Agents

• Silver sulfadiazine is an effective agent with low toxicity and few side effects, but the emergence of resistant Gram-negative bacilli, including Pseudomonas aeruginosa, is a concern 3.
• Silver-containing dressings are generally recommended over antiseptics or antibiotics, regardless of the depth of the burn 4.
• The choice of topical antimicrobial agent depends on the clinical scenario, burn-wound depth, and burn severity 4.

Dressing Changes

• The frequency of dressing changes can impact wound outcomes, with once-daily dressing changes potentially decreasing length-of-stay, pain levels, and hospital-acquired complications 6.
• The amount of silver sulfadiazine used per patient per hospital stay can also be reduced with once-daily dressing changes 6.