What is the recommended topical treatment for first degree burn pain?

Topical Treatment for First Degree Burn Pain

For first degree burn pain, cooling the burn with clean running water (15-25°C) for 5-20 minutes followed by application of a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin is recommended as the primary topical treatment. 1

Initial Management

• Immediately cool the burn with clean running water (15-25°C) for 5-20 minutes
  • Do NOT apply ice directly to burns as this can worsen tissue damage 1
  • Remove any contaminated clothing and jewelry
• After cooling, gently pat the area dry with a clean cloth

Topical Treatment Options

1. First-line treatment:

   • Apply a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin 1
   • Cover with a clean, non-adherent dressing (such as Telfa)

2. Pain management:

   • Implement multimodal analgesia based on pain assessment
   • Over-the-counter oral analgesics (acetaminophen or NSAIDs) for pain control 1
   • For more severe pain, consider topical lidocaine preparations 2
     • A 5% lidocaine cream has shown significant pain relief for partial-thickness burns 2
     • Lidocaine-prilocaine cream 5% (LPC) has demonstrated effective pain reduction in pediatric burn patients 3

Wound Care

• Leave any intact blisters undisturbed to improve healing and reduce pain 1
• Keep the burn area clean and covered with a loose, sterile dressing
• Change dressings as needed, typically every 24-48 hours
• Monitor for signs of infection (increased pain, redness, swelling, purulent discharge)

Important Considerations

• Do NOT apply home remedies or butter on burns 1
• Do NOT break blisters intentionally 1
• Do NOT apply topical antibiotics prophylactically for first-degree burns 1
• First-degree burns typically heal within 7-14 days with minimal scarring if proper wound care is maintained 1

When to Seek Medical Attention

• Burns involving face, hands, feet, or genitalia
• Burns covering >10% total body surface area (TBSA) in children or >20% TBSA in adults
• Signs of infection
• Worsening pain despite appropriate home management
• Burns that do not show signs of healing after 1 week

The evidence strongly supports cooling as the initial intervention for burn pain relief, followed by application of a greasy emollient and appropriate dressing. This approach not only reduces pain but also promotes optimal healing conditions and minimizes the risk of complications.