What over-the-counter (OTC) treatments are available for second-degree burns?

Over-the-Counter Treatments for Second-Degree Burns

For second-degree burns, immediate cooling with cold tap water (15-25°C) for at least 15 minutes, followed by application of antibiotic ointment (such as bacitracin, neomycin, polymyxin B) and covering with a sterile, non-adherent dressing is the recommended over-the-counter treatment approach. 1

Initial Management

1. Immediate cooling:

   • Cool the burn with cold (15-25°C) tap water until pain is relieved 1
   • Continue for at least 15 minutes
   • NEVER apply ice directly to burns as this can cause further tissue damage 1

2. Blister management:

   • Leave burn blisters intact as this improves healing and reduces pain 1
   • Protect intact blisters with loose sterile dressing to prevent accidental rupture 1

OTC Topical Treatments

1. Antibiotic ointments:

   • Apply a thin layer of antibiotic ointment such as triple antibiotic ointment (bacitracin zinc, neomycin sulfate, polymyxin B sulfate) 1, 2
   • Some formulations include pain relief ingredients like pramoxine HCl 2
   • Apply approximately 1/16 inch layer to prevent bacterial infection 1

2. Dressings:

   • Cover with sterile, non-adherent dressing applied loosely 1
   • Change dressings regularly to monitor healing and prevent infection 1

Pain Management

For pain control, use OTC medications:

• First-line: Acetaminophen 1g every 4-6 hours 1
• Second-line: Add NSAIDs for inflammatory pain 1

When to Seek Medical Attention

Immediate medical attention is required for second-degree burns that:

• Involve face, hands, feet, or genitalia
• Cover >10% total body surface area (TBSA) in children
• Cover >20% TBSA in adults 1

Follow-up Care

• Monitor for signs of infection (increased pain, redness, swelling, purulent drainage)
• Begin early range of motion exercises to prevent contractures 1
• Regular wound assessment for signs of healing or complications 1

Cautions and Pitfalls

• Do not use home remedies like butter, oil, or toothpaste on burns as these can trap heat and increase damage
• Avoid using adhesive dressings that may stick to the burn and cause further injury when removed
• People with diabetes are at increased risk of complications and infection, and should consider early medical consultation 3
• Long-term complications of second-degree burns include pruritus, hypertrophic scarring, and permanent hyperpigmentation 3

The 2024 consensus on second-degree burn treatment emphasizes the importance of proper wound care to prevent progression of injury into deeper layers of the dermis 4. While advanced hydrogel dressings show promise for second-degree burn management 5, standard OTC treatments following the guidelines above remain the recommended first-line approach for minor second-degree burns.