What is the management of first-degree burns?

Management of First-Degree Burns

First-degree burns should be treated with immediate cooling under running water (15-25°C) for at least 15 minutes, followed by application of a moisturizing O/W emulsion and pain management with acetaminophen or NSAIDs. 1, 2

Initial Assessment and Treatment

1. Stop the burning process immediately:

   • Remove any contaminated clothing, jewelry, or material from the affected area 1
   • Cool the burn with cold (15-25°C) tap water until pain is relieved (at least 15 minutes) 1
   • Do NOT apply ice directly to burns as this can worsen tissue damage 1

2. Wound assessment:

   • Confirm first-degree burn characteristics: erythema, pain, minimal swelling, no blisters
   • First-degree burns only involve the epidermis 3
   • Assess total body surface area (TBSA) affected

Wound Care

• Apply appropriate topical treatment:

  • Use aqueous emulsions with small amounts of well-tolerated lipids (O/W emulsions) 2
  • Foam sprays and lotions are ideal as they are easy and painless to apply 2
  • The water component evaporates to provide cooling and reduce inflammation
  • The lipid component helps repair the damaged skin barrier and prevents excessive drying 2

• Dressing considerations:

  • For small first-degree burns, dressings may not be necessary
  • For larger areas, use sterile, non-adherent dressings applied loosely 1
  • Change dressings as needed to maintain cleanliness

Pain Management

• Pharmacological options:

  • First-line: Acetaminophen 1g every 4-6 hours 1
  • Second-line: Add NSAIDs for inflammatory pain 1
  • Opioids are typically not necessary for first-degree burns 1

• Non-pharmacological techniques:

  • Cool compresses can provide additional pain relief
  • Virtual reality or hypnosis techniques may help reduce pain intensity and anxiety in more sensitive patients 1

Follow-up and Monitoring

• Monitor for signs of healing
• First-degree burns typically heal within 7-10 days without scarring
• Watch for signs of infection (increasing pain, redness, swelling, purulent drainage)
• If burn appears to be worsening or not healing appropriately, reassess for potential deeper injury

Important Considerations and Pitfalls

• Avoid topical corticosteroids as their superiority to vehicle alone has not been demonstrated for first-degree burns 2
• Prophylactic antibiotics are not indicated for first-degree burns and may increase bacterial resistance 3
• Do not apply home remedies like butter, oil, or toothpaste as these can trap heat and increase risk of infection
• Seek immediate medical attention if:
  • Burns involve face, hands, feet, or genitalia
  • Burns cover >10% TBSA in children or >20% TBSA in adults
  • Patient is very young, elderly, or has significant comorbidities (especially diabetes) 1, 3

First-degree burns are often inadequately treated despite being the most common type of burn injury 2. With proper initial cooling, appropriate topical treatment, and pain management, these injuries should heal completely without complications.