From the Guidelines
For a second-degree burn, it is recommended to apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera after cooling with running water, as suggested by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. When managing a second-degree burn, it is essential to prioritize cooling the burn with running water to decrease the need for subsequent care and reduce the risk of further injury.
- Cooling with running water is a beneficial intervention with little risk of harm, as supported by a meta-analysis of observational data 1.
- After cooling, applying a topical ointment can help prevent infection and promote healing.
- Petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera are reasonable options for small partial-thickness burns being managed at home, according to the 2024 guidelines 1.
- It is also important to cover the burn with a clean nonadherent dressing to protect the wound and promote healing.
- Before applying any ointment, cool the burn with cool (not cold) running water for about 10-15 minutes, then pat dry gently.
- Never use ice, butter, or toothpaste on burns, as these can cause further damage and delay healing.
- Second-degree burns involve damage to both the outer layer (epidermis) and part of the underlying layer (dermis) of skin, causing blistering, redness, and pain.
- These antimicrobial ointments help prevent infection while the skin heals.
- Seek immediate medical attention for burns that are larger than 3 inches, on the face, hands, feet, genitals, or major joints, or if you notice signs of infection such as increased pain, redness, swelling, or discharge.
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 burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions.
The recommended ointment for a second-degree burn is silver sulfadiazine cream, USP 1% 2. It should be applied once to twice daily to a thickness of approximately one sixteenth of an inch, and reapplied as necessary 2.
From the Research
Recommended Ointments for Second-Degree Burns
- Silver sulfadiazine cream is a commonly used topical agent for the treatment of second-degree burns, as shown in studies 3, 4, 5, 6, 7.
- A fixed combination of 0.2% hyaluronic acid and 1% silver sulfadiazine (HA-SSD) has been found to cause a significantly more rapid re-epithelialization of burns compared to silver sulfadiazine alone 3.
- Fundermol herbal ointment has been shown to accelerate burn wound healing and can be considered as a good replacement for current treatments of burn wounds 4.
- Sea buckthorn cream has been found to have a greater clinical efficacy than 1% silver sulfadiazine for healing second-degree burns, with a shorter period of wound healing 6.
- Hydrocolloid dressings, such as Duoderm, have been shown to be superior to silver sulfadiazine cream in the outpatient management of second-degree burns, with better wound healing, repigmentation, and patient comfort 7.
Considerations for Ointment Selection
- The choice of ointment may depend on the individual patient's needs and the specific characteristics of the burn wound.
- It is essential to consider the potential side effects of silver sulfadiazine, such as allergic reactions and silver staining of the treated burn wound 5.
- The use of alternative ointments, such as fundermol and sea buckthorn, may offer benefits in terms of accelerated wound healing and reduced side effects.