Is baking soda (sodium bicarbonate) effective for treating skin burns?

Baking Soda for Skin Burns: Evidence and Recommendations

Baking soda (sodium bicarbonate) is not recommended for treating skin burns and may potentially cause harm by delaying appropriate medical care. Based on available evidence, there is no support for using baking soda as a treatment for burns, and its alkaline nature could potentially worsen tissue damage.

Appropriate Burn Management

Initial Management

• Clean burns gently using warmed sterile water or saline, or a dilute antimicrobial solution such as chlorhexidine (1/5000) 1
• For chemical burns, particularly alkaline burns, rapid irrigation with water is the standard approach 2
• Avoid applying any alkaline substances (like baking soda) to burns, as alkaline substances can cause significant tissue damage 2

Wound Care

• Apply appropriate dressings to burn wounds, such as non-adherent dressings (e.g., Mepitel™ or Telfa™) 1
• Use a greasy emollient, such as 50% white soft paraffin with 50% liquid paraffin, over the epidermis including denuded areas 1
• Consider topical antimicrobial agents only for sloughy areas, based on microbiological advice 1

Scientific Evidence on Burn Treatment

Alkaline Burns and Neutralization

• Research suggests that alkaline burns may benefit from neutralization with weak acids (such as 5% acetic acid/vinegar) rather than water irrigation alone, showing more rapid return to physiologic pH and improved healing 3
• However, applying alkaline substances (like baking soda) to any burn would be counterproductive and potentially harmful 2

Acidic Environment for Healing

• Some research indicates that topical acidification of experimental deep partial thickness burns promoted healing compared to neutral or alkaline solutions 4
• This further suggests that applying an alkaline substance like baking soda would be counterproductive to the healing process 4

Potential Risks of Baking Soda Misuse

• Baking soda misuse as a home remedy has been associated with significant toxicity, including electrolyte imbalances and metabolic alkalosis when ingested 5
• Using baking soda for burns may delay appropriate medical care, potentially complicating or exacerbating the existing injury 5
• The alkaline nature of baking soda could theoretically worsen tissue damage in burns 2

Pain Management for Burns

• For pain management in burns, multimodal analgesia is recommended, with medications titrated based on validated comfort and analgesia assessment scales 1
• Intravenous ketamine can be combined with other analgesics to treat severe burn-induced pain 1
• Non-pharmacological techniques can be combined with analgesic drugs for dressing changes when appropriate 1

When to Seek Medical Care

• Burns involving >10% body surface area should be evaluated by healthcare professionals 1
• Burns to the face, hands, feet, genitalia, or major joints require medical attention 1
• Chemical burns, electrical burns, and burns with signs of infection need prompt medical evaluation 1
• Any burn that appears to be deep (affecting deeper layers of skin) requires medical assessment 1

In conclusion, there is no scientific evidence supporting the use of baking soda for treating skin burns. Instead, proper wound cleansing, appropriate dressings, and seeking medical attention when needed are the recommended approaches for burn management.