What is the best treatment for a second-degree burn?

Best Treatment for Second-Degree Burns

The best treatment for second-degree burns includes immediate cooling with cool water for at least 10 minutes, protecting intact blisters with sterile dressings, and applying appropriate antimicrobial agents only to sloughy areas. 1

Immediate First Aid

1. Apply cool or cold potable water (15-25°C) to the burn for at least 10 minutes

   • Reduces pain and limits tissue damage
   • Avoid using ice directly as it can cause tissue ischemia 1
   • This is a critical first step that should not be skipped 2

2. After cooling:

   • Gently clean the area with mild soap and water
   • Pat dry with sterile gauze
   • Apply a sterile, dry dressing loosely 1

Blister Management

• Intact blisters:

  • Protect with loose sterile dressing to prevent rupture 1
  • Leave intact as they serve as a natural barrier against infection 1

• Ruptured blisters:

  • Decompress by piercing and expressing fluid
  • Keep detached epidermis in place as a biological dressing
  • Apply non-adherent dressing 1

Antimicrobial Treatment

• Apply topical antimicrobial agents only to sloughy areas, not intact blisters 1
• Silver sulfadiazine cream 1% is FDA-approved for prevention and treatment of wound sepsis in second-degree burns 3
• Apply a thin layer of antibiotic ointment for superficial burns (if no known allergies) 1

Dressing Protocol

1. Cover the burn with a sterile, non-adherent dressing
2. Secure loosely to reduce trauma and promote healing
3. Change dressings as needed to maintain a clean, dry environment 1
4. Minimize dressing changes to reduce pain and trauma to healing tissue

Pain Management

• Implement multimodal analgesia based on validated pain assessment scales:
  • Over-the-counter analgesics (acetaminophen or NSAIDs)
  • Consider stronger analgesics for severe pain
  • Warm wound cleansing solution to reduce pain during cleaning 1

When to Seek Medical Attention

Immediate medical evaluation is required for burns that:

• Involve face, hands, feet, or genitals
• Cause significant difficulty breathing
• Are circumferential (wrap around extremities)
• Cover >10% TBSA in children or >20% in adults
• Show signs of infection (increased redness, warmth, swelling, discharge, or fever) 1

Monitoring for Complications

• Check for signs of infection at each dressing change
• Assess distal circulation, sensation, and motor function every 15-30 minutes if burn is on an extremity
• Monitor for signs of compartment syndrome (severe pain, pallor, paresthesia, pulselessness, paralysis) 1

Important Cautions

• Avoid home remedies or butter on burns
• Do not apply topical antibiotics prophylactically
• Never use direct ice application 1

The 2024 Consensus on Treatment of Second-Degree Burn Wounds emphasizes the importance of standardized approaches to burn management, considering factors such as burn site, patient age, and burn area 4. Research has shown that appropriate dressings can significantly reduce hospital stay, frequency of dressing changes, and pain 5, 6.