From the Guidelines
Third-degree burns require immediate emergency medical attention and should not be treated at home, with treatment typically involving cleaning the wound, removing dead tissue (debridement), intravenous fluids to prevent shock, antibiotics to prevent infection, pain management, and often skin grafting surgery, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. While waiting for help, it is essential to ensure the victim is no longer in contact with the burning source, remove clothing and jewelry from the burned area unless stuck to the skin, cover the burn loosely with a clean, sterile bandage or cloth, and elevate the burned area above heart level if possible, as suggested by the guidelines 1. Some key points to consider in the treatment of third-degree burns include:
- Do not apply ice, butter, ointments, or break blisters, as this can cause further damage to the burn area 1.
- Pain management is crucial, and multimodal analgesia can be used, with all analgesic medications titrated on the basis of validated comfort and analgesia assessment scales, as recommended by the management of severe thermal burns in the acute phase in adults and children guidelines 1.
- Non-pharmacological techniques, such as cooling limited burned surfaces and covering burns with a fatty substance, may also improve pain control, as suggested by the guidelines 1.
- The use of written protocols for the management and regular assessment of pain should be encouraged, and ketamine can be an effective drug for burn-induced pain, limiting morphine consumption, as recommended by the management of severe thermal burns in the acute phase in adults and children guidelines 1. It is also important to note that third-degree burns are severe because they destroy all layers of skin and can damage underlying tissues, nerves, and blood vessels, leading to potential complications like infection, shock, and permanent scarring, as highlighted by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Recovery requires specialized care, possibly including physical therapy, and may take months depending on the burn's size and severity, as suggested by the guidelines 1.
From the FDA Drug Label
Silver sulfadiazine cream, USP 1% is a topical antimicrobial drug indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second and third degree burns. The treatment for a third-degree (full-thickness) burn includes the use of silver sulfadiazine cream, USP 1% as an adjunct for the prevention and treatment of wound sepsis 2.
- It is used as a topical antimicrobial drug.
- The use of silver sulfadiazine cream is part of the treatment, but the label does not provide a comprehensive treatment plan for third-degree burns.
From the Research
Treatment for Third-Degree Burns
- Patients with third-degree (full-thickness) burns should automatically be referred to a burn center 3.
- There is no specific treatment mentioned in the studies for third-degree burns, but it can be inferred that treatment may involve wound care and possibly surgery.
- In severe cases of third-degree burns, palliative care may be the only option, including mechanical ventilation, fluid therapy, and analgesia 4.
- Silver sulfadiazine has been found to be effective in treating burns, including third-degree burns, with 85.7% of the wound area showing granulation tissue and 75-100% of the wound area showing epithelialisation 5.
- Amnion dressing (biological dressing) + silver sulfadiazine cream has been shown to be an effective treatment option for deep second- and third-degree acute burn wounds, with a reduction in recovery time, cost, and pain intensity, and higher patient satisfaction compared to standard silver sulfadiazine cream dressings 6.
Wound Care and Dressings
- Silver sulfadiazine-impregnated collagen dressing has been compared to conventional burn dressings in second-degree burns, with improved wound healing and patient satisfaction in the SIC-treated group 7.
- Amnion dressing (biological dressing) + silver sulfadiazine cream has been shown to be an effective treatment option for deep second- and third-degree acute burn wounds, with a reduction in recovery time, cost, and pain intensity, and higher patient satisfaction compared to standard silver sulfadiazine cream dressings 6.