What is the treatment for a first-degree burn of the penile shaft?

Treatment for First-Degree Burns of the Penile Shaft

For first-degree burns of the penile shaft, immediate cooling with cold running water for 20 minutes is the recommended first-line treatment, followed by application of a non-adherent dressing with a thin layer of emollient or antimicrobial cream. 1, 2

Initial Management

1. Immediate Cooling

   • Apply cold running water for 20 minutes to the burned area 2, 1
   • This is effective for up to three hours after the injury 3
   • Cooling reduces burn depth and decreases the percentage of burns requiring hospital admission 2

2. Wound Assessment

   • Confirm it is a first-degree burn (superficial, involving only epidermis)
   • Look for erythema, mild swelling, and pain without blistering 4
   • Assess for any signs that might indicate deeper injury requiring specialist referral

Wound Care

1. Cleansing

   • Gently irrigate with warmed sterile water, saline, or dilute chlorhexidine (1/5000) 1
   • Avoid scrubbing the area as this can cause further damage

2. Dressing Application

   • Apply a non-adherent dressing (e.g., Mepitel™ or Telfa™) 1
   • For first-degree burns, aqueous emulsions with small amounts of well-tolerated lipids (O/W emulsions) are ideal 5
   • Foam sprays and lotions are recommended as they are easy and painless to apply 5

3. Topical Treatment Options

   • Apply a greasy emollient (50% white soft paraffin with 50% liquid paraffin) over the epidermis 1
   • For antimicrobial protection, a thin layer of 1% silver sulfadiazine cream can be considered 1
   • Avoid topical corticosteroids as their superiority to vehicle has not been demonstrated 5

Pain Management

• Implement multimodal analgesia:
  • Acetaminophen (first-line)
  • NSAIDs if not contraindicated
  • Opioids only if necessary for severe pain 1

Special Considerations for Penile Burns

• Avoid indwelling catheters unless absolutely necessary 6
• Conservative management is recommended for first-degree genital burns 6
• Monitor for signs of urethral involvement (difficulty urinating, blood in urine)
• Due to the sensitive location, consider early follow-up to ensure proper healing

Monitoring and Follow-up

• Monitor for signs of infection:

  • Increasing pain, redness, swelling
  • Purulent discharge
  • Fever or systemic symptoms 1

• Watch for complications:

  • Delayed healing
  • Scarring of the penile shaft (rare in first-degree burns but possible)
  • Hyperpigmentation 4

When to Refer to a Specialist

• If burn appears deeper than initially assessed
• If there are signs of infection not responding to treatment
• If the burn involves the urethra or other deeper structures
• If healing is delayed beyond expected timeframe
• Burns involving genitalia generally warrant consideration for specialist evaluation, even if superficial 1, 4

Common Pitfalls to Avoid

• Do not use ice or very cold water directly on the burn as this can cause tissue damage
• Avoid prophylactic oral antibiotics unless there are signs of infection 3, 4
• Do not apply adhesive dressings directly to the burn
• Avoid home remedies like butter, toothpaste, or oils that can trap heat and increase risk of infection

First-degree burns of the penile shaft typically heal well with appropriate first aid and wound care. The key is prompt cooling followed by gentle care with appropriate dressings to maintain a clean, moist healing environment.