First Degree Burn Treatment
First degree burns should be immediately cooled with clean running water for 5-20 minutes as the primary treatment intervention. 1
Initial Assessment and Management
Immediate Cooling
- Cool the burn immediately with clean running water 1
- Duration: 5-20 minutes is reasonable 1
- If clean running water is unavailable, ice wrapped in cloth may be used for superficial burns with intact skin 1
- Monitor children for signs of hypothermia during cooling 1
Pain Management
- Over-the-counter pain medications (acetaminophen or NSAIDs) are appropriate for pain relief 1
- Remove jewelry from the affected area before swelling occurs 1
Post-Cooling Care
Dressing Application
After cooling is complete:
- For burns with intact skin: Loosely cover with clean cloth or non-adherent dry dressing 1
- For small burns being managed at home: Apply one of the following 1:
- Petrolatum
- Petrolatum-based antibiotic ointment
- Aloe vera
- Honey
Follow-up Care
- First-degree burns generally heal without scarring and have low infection risk 1
- Aqueous emulsions with small amounts of well-tolerated lipids (O/W emulsions) are suitable for ongoing care 2
- Foam sprays and lotions are ideal because they're easy and painless to apply 2
When to Seek Medical Care
Immediate medical attention is required for:
- Burns involving the face, hands, feet, or genitalia 1
- Burns with signs of inhalation injury (soot around nose/mouth, difficulty breathing) 1
- Full-thickness burns 1
- Large partial-thickness burns 1
- Burns covering >10% body surface area (>5% in children) 1
Important Considerations
Efficacy of Cooling
- Cooling with running water is an established beneficial intervention with little risk of harm 1
- Meta-analysis data shows decreased need for subsequent care in patients who receive immediate cooling with clean running water 1
- The optimal duration of cooling remains somewhat controversial, but 5-20 minutes is the current recommendation 1, 3
Common Pitfalls to Avoid
- Avoid applying ice directly to the skin as it may cause further tissue damage
- Don't apply butter, oil, or home remedies to burns
- Don't use topical corticosteroids as superiority to vehicle has not been demonstrated 2
- Don't delay cooling - immediate application is critical for best outcomes
- Don't use prophylactic antibiotics for outpatient management of superficial burns 4
First-degree burns involve only the epidermal layer and typically heal well with proper first aid care. The evidence strongly supports immediate cooling as the most effective initial intervention, followed by appropriate covering and pain management.