What medication is recommended for skin burns?

Recommended Medications for Skin Burns

For skin burns, silver sulfadiazine cream 1% is the first-line topical medication, applied once to twice daily to a thickness of approximately 1/16 inch, with multimodal pain management including acetaminophen, NSAIDs, and opioids as needed based on burn severity. 1, 2, 3

Initial Burn Management

Immediate Care

1. Cool burns with room temperature (15° to 25°C) tap water for 10-20 minutes 1
2. Do not apply ice directly to burns as this can worsen tissue damage 1
3. Leave burn blisters intact to improve healing and reduce pain 1
4. Cover burns with sterile, non-adherent dressings 1

Pain Management

• First-line: Acetaminophen 1g every 4-6 hours 1, 3
• Second-line: Add NSAIDs for inflammatory pain 1
• Severe pain: Short-acting opioids and ketamine for more severe burns 4, 1
• Non-pharmacological: Consider virtual reality or hypnosis techniques to reduce pain intensity and anxiety when appropriate 4, 1

Topical Medication Selection

Silver Sulfadiazine Cream 1%

• Primary indication: Standard treatment for partial-thickness burns 2, 3
• Application: Apply once to twice daily to a thickness of approximately 1/16 inch 2
• Reapplication: Whenever necessary after the cream has been removed by patient activity 2
• Duration: Continue until satisfactory healing has occurred or until the burn site is ready for grafting 2

Silver sulfadiazine is the most frequently used topical prophylactic agent because it is relatively inexpensive, easy to apply, well-tolerated by patients, and has good activity against most burn pathogens 5.

Other Topical Options

• Antibiotic ointment for superficial injuries if no allergies are present 1
• Mafenide acetate has superior eschar-penetrating characteristics, making it useful for treating burn wound sepsis, but its use must be limited due to potential systemic toxicity 5

Burn Severity Assessment and Referral Criteria

Refer patients to a burn specialist if they have:

• Full-thickness burns
• Circumferential burns
• Burns on the face, hands, feet, genitals, or perineum

• 10% TBSA in children

• 20% TBSA in adults 1

Important Considerations and Pitfalls

Common Pitfalls to Avoid

• Applying ice directly to burns (worsens tissue damage) 1
• Breaking blisters (increases infection risk and pain) 1
• Using prophylactic systemic antibiotics (not indicated for most patients) 3
• Delaying appropriate pain management (can increase anxiety and worsen outcomes) 4

Special Considerations

• For extensive burns, fluid resuscitation should be initiated with careful monitoring 1
• Nutritional support should be started within 12 hours after severe burn injury 1
• Monitor for signs of compartment syndrome in extremity injuries (pain, pallor, paresthesia, pulselessness, paralysis) 1

The management of burns requires a personalized approach based on the depth, extent, and location of the burn. While silver sulfadiazine remains the standard topical treatment for partial-thickness burns, the pain management approach should be multimodal, combining pharmacological and non-pharmacological methods to optimize patient comfort and healing outcomes 4, 1, 3.