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

Treatment of Second-Degree Burns

For second-degree burns, the proper treatment is to cool the burn with room temperature running water (15-25°C) for at least 10 minutes, leave blisters intact, clean the wound, apply a thin layer of 1% silver sulfadiazine cream, and cover with a sterile non-adherent dressing. 1

Initial Management

1. Immediate cooling:

   • Cool the burn with running water at room temperature (15-25°C) for at least 10 minutes 1
   • This helps limit tissue damage and reduces pain
   • Avoid ice or very cold water as this can worsen tissue damage

2. Wound assessment:

   • Evaluate the burn depth, size, and location
   • Second-degree burns involve partial thickness of the skin with blistering
   • Use the Lund and Browder method for accurate measurement of total body surface area (TBSA) affected 1
   • Seek immediate medical attention for:
     • Burns on face, hands, feet, or genitalia
     • Burns covering >10% TBSA in children or >20% TBSA in adults 1

Wound Care

1. Blister management:

   • Leave blisters intact to improve healing and reduce pain 1
   • Intact blisters serve as a natural barrier against infection
   • Protect blisters with loose sterile dressing to prevent accidental rupture

2. Cleaning and debridement:

   • Gently clean the wound with mild soap and water
   • Carefully remove any debris or dead tissue
   • Avoid aggressive scrubbing that could damage viable tissue

3. Topical treatment:

   • Apply a thin layer (approximately 1/16 inch) of 1% silver sulfadiazine cream 1, 2
   • Silver sulfadiazine is specifically indicated for prevention and treatment of wound sepsis in second and third-degree burns 2
   • Alternative: Apply antibiotic ointment if no known allergies 1

4. Dressing application:

   • Cover with sterile, non-adherent dressing applied loosely 1
   • Change dressings once to twice daily 2
   • Reapply medication immediately after hydrotherapy or when removed by patient activity 2

Pain Management

• First-line: Acetaminophen 1g every 4-6 hours 1
• Second-line: Add NSAIDs for inflammatory pain 1
• For severe pain: Consider stronger analgesics as prescribed by healthcare provider
• Use multimodal analgesia for better pain control 1

Follow-up Care

1. Ongoing wound assessment:

   • Monitor for signs of infection (increased pain, redness, swelling, warmth, purulent drainage)
   • Check for proper healing progression
   • Continue treatment until satisfactory healing has occurred 2

2. Hydration and nutrition:

   • Maintain adequate hydration
   • Ensure proper nutrition to support wound healing 1

3. Rehabilitation:

   • Begin gentle range of motion exercises as healing progresses
   • Consider massage therapy to soften scar tissue once wound is completely healed 1

When to Seek Medical Attention

• Signs of infection
• Worsening pain
• Burns that appear to be deepening
• Burns covering large areas or involving face, hands, feet, or genitalia
• Burns that don't show signs of healing within 2 weeks

Common Pitfalls to Avoid

• Using ice or very cold water for cooling (can worsen tissue damage)
• Breaking blisters (increases infection risk)
• Applying home remedies like butter, oil, or toothpaste (can trap heat and increase damage)
• Using cotton balls or materials that can shed fibers into the wound
• Delaying treatment for burns in critical areas or covering large surface areas
• Discontinuing silver sulfadiazine treatment prematurely while infection risk remains 2

The most recent consensus on second-degree burn treatment (2024) emphasizes the importance of standardized approaches to burn management, highlighting the need for specific protocols based on burn site, patient age, and burn area 3. This aligns with the guidelines that recommend tailored approaches while following core principles of cooling, gentle cleaning, antimicrobial application, and appropriate dressing.