What is the treatment for a small second-degree burn?

Treatment for Small Second-Degree Burns

The optimal treatment for a small second-degree burn includes immediate cooling with cold running water for 20 minutes, keeping blisters intact, applying a thin layer of 1% silver sulfadiazine cream, and covering with a non-adherent dressing. 1

Initial Management

1. Cooling the burn:

   • Apply cold running tap water (15-25°C) for 20 minutes 1
   • This reduces burn depth and decreases the need for hospital admission
   • Avoid using ice directly on the burn as it can worsen tissue damage

2. Blister management:

   • Keep blisters intact to maintain a sterile environment and reduce infection risk 1
   • If blisters are large or painful, they may be decompressed by piercing while leaving the roof intact to act as a biological dressing

Wound Care

1. Cleansing:

   • Gently irrigate the wound with warmed sterile water, saline, or dilute chlorhexidine (1/5000) 1

2. Topical treatment:

   • Apply a thin layer (approximately 1/16 inch) of 1% silver sulfadiazine cream 1, 2
   • Silver sulfadiazine is specifically indicated for prevention and treatment of wound sepsis in second and third-degree burns 2
   • Reapply once to twice daily or whenever the cream has been removed by patient activity

3. Dressing:

   • Cover with non-adherent dressings (e.g., Mepitel™ or Telfa™) 1
   • For sloughy areas, consider silver-containing products

Pain Management

• Use multimodal analgesia based on validated comfort and pain assessment scales 1
• Offer analgesia prior to any blister procedure or dressing change
• Non-pharmacological techniques may be helpful as adjuncts

Monitoring for Complications

• Watch for signs of infection: increasing pain, redness, swelling, discharge, fever, or systemic symptoms 1
• Do not administer systemic antibiotics prophylactically; only use when there are clinical signs of infection
• Take wound swabs for bacterial and fungal culture if infection is suspected

When to Seek Medical Attention

Immediate medical attention is required for burns that:

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

Prevention of Complications

• Begin early range of motion exercises to prevent contractures 1
• Apply moisturizers to the healed burn to prevent dryness and cracking
• Protect the healing burn from sun exposure

Common Pitfalls to Avoid

• Applying ice directly to the burn (causes vasoconstriction and can worsen tissue damage)
• Breaking blisters (increases infection risk)
• Using home remedies like butter, oil, or toothpaste (can trap heat and worsen burns)
• Delaying cooling (immediate cooling is crucial for limiting burn progression)
• Neglecting signs of infection (requires prompt medical attention)

The evidence strongly supports immediate cooling with water as the most important first step in burn management, followed by appropriate wound care with silver sulfadiazine and non-adherent dressings to promote healing and prevent infection in second-degree burns 1, 2, 3.