What is the management for second-degree sunburn with swelling and blistering?

From the Guidelines

Management of second-degree sunburn with swelling and blistering requires prompt attention to reduce pain, prevent infection, and promote healing, and the most effective approach is to cool the affected area with cold compresses or cool water for 10-15 minutes several times daily, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The goal of treatment is to reduce pain, prevent infection, and promote healing.

• Cool the affected area with cold compresses or cool (not ice-cold) water for 10-15 minutes several times daily, as this has been shown to decrease the need for subsequent care in patients with thermal burns 1.
• Take over-the-counter pain relievers such as ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 4-6 hours) to reduce pain and inflammation, as these are well-tolerated and generally recommended for burn pain 1.
• Apply aloe vera gel or moisturizers containing aloe to soothe the skin, but avoid petroleum-based products which trap heat, as petrolatum, honey, and aloe have been shown to improve healing time in patients with partial-thickness burns 1.
• Do not break blisters as they protect against infection; if they break naturally, gently clean with mild soap and water, apply an antibiotic ointment like bacitracin or polysporin, and cover with a non-stick bandage, as leaving blisters intact improves healing and reduces pain 1.
• Stay hydrated by drinking plenty of water to help your skin heal.
• Avoid sun exposure to the burned area until fully healed. If the burn covers a large area, affects the face or genitals, shows signs of infection (increased pain, redness, warmth, pus, or red streaks), or is accompanied by fever, nausea, or severe pain, seek medical attention immediately, as these may require surgical intervention or specialized care 1.

From the Research

Management of Second-Degree Sunburn with Swelling and Blistering

• The management of second-degree sunburn with swelling and blistering involves symptomatic treatment of UV light-induced symptoms, including erythema, pain, and pruritus 2.
• For second-degree burns, the use of aloe vera cream has been shown to be more effective than silver sulfadiazine cream in promoting re-epithelialization and healing 3.
• However, another study found that aloe vera cream had no efficacy in sunburn treatment or prevention when compared to placebo 4.
• In terms of blister management, one approach is to puncture the blister in a sterile way, keep the overlying skin as a biological cover, and apply a moist sterile biological dressing 5.
• Alternatively, the burn blister fluid can be aspirated and immediately sprayed over the other areas of the same wound as an adjuvant therapy for second-degree superficial burn wounds 5.
• Cooling of the burn wound has also been shown to be beneficial in improving wound healing, especially when blisters are left intact 6.
• The removal of blisters can eliminate any therapeutic effect of cooling or other treatments, and can lead to whole-thickness or very deep partial-thickness skin loss 6.