What topical ointment is recommended for treating burns?

Recommended Ointment for Burn Treatment

For superficial burns, apply a thin layer of antibiotic ointment (if no known allergies), while silver sulfadiazine cream is recommended for second and third degree burns to prevent wound infection. 1, 2

Burn Assessment and Treatment Algorithm

Step 1: Immediate First Aid

• Cool the burn with cool or cold potable water (15-25°C) for at least 10 minutes
• Do NOT use ice or ice water directly on the burn as this can cause tissue ischemia
• Do NOT apply butter, oil, or home remedies to burns 1

Step 2: Assess Burn Severity

• Superficial burns (first-degree): Redness, pain, no blisters
• Partial-thickness burns (second-degree): Blisters, pain, redness
• Full-thickness burns (third-degree): White/charred appearance, possibly painless

Step 3: Select Appropriate Topical Treatment

For Superficial Burns:

• Apply a thin layer of antibiotic ointment if there are no known allergies 1
• Petrolatum gel is an effective, affordable alternative that may lead to faster healing (mean 6.2 days vs 7.8 days with silver sulfadiazine) 3

For Partial and Full-Thickness Burns:

• Silver sulfadiazine cream 1% is the standard treatment for second and third-degree burns 2, 4
• It is relatively inexpensive, easy to apply, well-tolerated, and effective against most burn pathogens 5

Important Considerations

When to Seek Medical Attention

Immediately seek medical evaluation for burns that:

• Have blistering or broken skin
• Involve the face, hands, feet, or genitals
• Cover a large surface area (>10% TBSA in children, >20% TBSA in adults)
• Cause difficulty breathing
• Show signs of infection 1

Wound Care Best Practices

• Leave burn blisters intact to improve healing and reduce pain
• Cover the burn with a sterile, non-adherent dressing applied loosely
• Apply topical antimicrobial agents only to sloughy areas, not intact blisters 1

Pain Management

• Use acetaminophen as first-line treatment for pain associated with minor burns
• NSAIDs can also be used for pain management
• For severe burns, stronger analgesics may be necessary 1, 4

Common Pitfalls to Avoid

1. Do not apply ice directly to burns - this can worsen tissue damage
2. Do not break blisters intentionally - this increases infection risk
3. Do not use home remedies like butter or oils on burns
4. Do not apply topical antibiotics prophylactically to intact blisters 1

Special Considerations for Complex Burns

• For infected burns or burns with eschar, mafenide acetate may be preferred due to superior eschar-penetrating characteristics 5
• Combination treatments (such as collagenase with polymyxin B sulfate/bacitracin) may result in faster wound healing than silver sulfadiazine alone in partial-thickness burns 6
• Compounded preparations containing bacitracin, silver sulfadiazine, and other antimicrobials have shown effectiveness against a broad spectrum of microorganisms 7