Treatment for Rope Burns
Rope burns should be treated by cooling with cool or cold potable water as soon as possible and for at least 10 minutes, followed by loosely covering the burn with a sterile, dry dressing. 1
Initial Management
Cooling the Burn
- Apply cool (not cold) running tap water to the rope burn for at least 10 minutes 1
- This should be done as soon as possible but can be effective up to 30 minutes after injury 1
- Cooling reduces pain, depth of injury, and the need for grafting 1
- Do NOT use ice or ice water as this can increase tissue damage 1
Blister Management
- Keep burn blisters intact to improve healing and reduce pain 1, 2
- For large blisters, the British Association of Dermatologists recommends decompressing (not deroofing) by piercing with a sterile needle at the base, leaving the blister roof intact to act as a biological dressing 2
- Select a site where fluid will drain by gravity and apply gentle pressure with sterile gauze to facilitate drainage 2
Wound Care
- After cooling, loosely cover the burn with a sterile, dry dressing 1
- Clean the affected area before applying any topical treatments 3
- Apply a thin layer of antimicrobial cream such as 1% silver sulfadiazine for second-degree burns 2
- For minor rope burns, bacitracin can be applied 1-3 times daily to help prevent infection and provide temporary pain relief 3
Pain Management
- Offer appropriate analgesia prior to any blister procedure 2
- Use a multimodal approach including acetaminophen, NSAIDs, and if necessary, opioids for more severe pain 2
When to Seek Medical Attention
Burns associated with any of the following should be evaluated by a healthcare provider 1:
- Blistering or broken skin
- Difficulty breathing
- Burns involving the face, neck, hands, or genitals
- Burns covering a large surface area
- Signs of infection (increasing pain, redness, swelling, discharge, fever)
Special Considerations
- Monitor for hypothermia when cooling large burns 1
- In remote settings where commercial topical antibiotics are unavailable, honey may be considered as an antimicrobial agent 1
- Avoid natural remedies such as potato peel dressings in standard settings 1
- Begin early range of motion exercises to prevent contractures for burns crossing joint surfaces 2
Common Pitfalls to Avoid
- Using ice or extremely cold water, which can worsen tissue damage 1
- Breaking blisters, which increases infection risk 1, 2
- Applying butter, oil, or home remedies that can trap heat and increase damage
- Delaying cooling, which should be initiated as soon as possible 1
- Using prophylactic systemic antibiotics, which should be avoided to prevent selecting for resistant bacteria 2
By following these guidelines, most minor rope burns can be effectively managed with first aid measures. However, any burn that is extensive, deep, or involves sensitive areas should be evaluated by a healthcare professional.