From the Guidelines
First-degree burns can be treated at home with simple measures, whereas second-degree burns require more careful attention and may need evaluation by a healthcare professional, especially if they are large or located on sensitive areas. The primary goal of treatment for both types of burns is to promote healing, prevent infection, and minimize scarring.
Key Differences in Treatment
- Cooling: Both first and second-degree burns should be cooled with cool (not cold) running water for about 10-15 minutes to stop the burning process, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
- Topical treatments: For small partial-thickness burns being managed at home, it may be reasonable to apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera and a clean nonadherent dressing to open burn wounds, as suggested by the 2024 guidelines 1.
- Pain management: Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help manage pain for both types of burns, with evidence showing that they are well-tolerated and generally recommended for burn pain 1.
- Wound care: Second-degree burns require more intensive care to prevent infection and promote proper healing, including daily dressing changes and antibiotic ointments, whereas first-degree burns can be covered loosely with a sterile, non-stick bandage if needed.
Special Considerations
- Second-degree burns larger than 3 inches in diameter, or those on the face, hands, feet, genitals, or major joints should be evaluated by a healthcare professional, as they may require surgical intervention or specialized care 1.
- Burns involving the face, hands, feet, and genitals may require surgical intervention to prevent permanent disability, and those with a large surface area can lead to significant fluid loss and multisystem organ failure, emphasizing the need for prompt medical attention 1.
From the Research
Treatment Differences
The treatment for first-degree (superficial) burns and second-degree (partial thickness) burns differs in several ways:
- First-degree burns can be treated with aqueous emulsions, such as O/W emulsions, which help to cool the skin, reduce inflammation, and accelerate the repair of the damaged skin barrier 2.
- Second-degree burns, on the other hand, may be treated with topical antimicrobial agents, such as triple-antibiotic ointment, or advanced occlusive dressings, such as silver-containing foam dressings 3.
- Topical antimicrobial agents, such as bacitracin, neomycin, silver sulfadiazine, and mafenide, are commonly used to control microbial colonization and prevent invasive infections in second-degree burns 4.
- Superficial partial-thickness burns (a type of second-degree burn) may take up to three weeks to heal and require advanced dressings to protect the wound and promote a moist environment, while deep partial-thickness burns require immediate referral to a burn surgeon for possible early tangential excision 5.
Wound Care
Proper wound care is essential for both first-degree and second-degree burns:
- First-degree burns can be managed with simple first-aid techniques, including cooling with water and applying aqueous emulsions 2.
- Second-degree burns require more advanced wound care, including the use of topical antimicrobial agents and dressings to promote a moist environment and prevent infection 3, 4.
- Accurate evaluation of the severity of the burn and initiation of appropriate treatment are necessary to prevent adverse effects on the subsequent treatment and course 6.