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

Initial Treatment for Second-Degree Burns

The initial treatment for a second-degree burn should begin with immediate cooling of the burn with clean running water for 5-20 minutes to limit burn depth progression and reduce pain. 1

Immediate First Aid Steps

• Cool the burn immediately with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2
• Remove all jewelry before swelling occurs to prevent constriction and vascular ischemia 1, 2
• Monitor children closely for signs of hypothermia during cooling, especially preadolescent children 1, 2
• If clean running water is not available, superficial burns with intact skin may be cooled with ice wrapped in cloth (but never apply ice directly to the burn) 1
• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain management 1

Wound Cleaning and Assessment

• Clean the wound with tap water, isotonic saline, or an antiseptic solution in a clean environment with appropriate pain control 1
• Assess the burn for size, depth, and location to determine appropriate management 1
• Burns involving face, hands, feet, genitals, or >10% body surface area in adults (>5% in children) require specialized burn center treatment 1, 2

Dressing Application

• For small partial-thickness burns managed at home, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1
• Cover with a clean non-adherent dressing to protect the wound 1
• For larger burns requiring medical attention, the type of dressing depends on the total burn surface area, wound appearance, and patient's general condition 1
• Silver sulfadiazine cream 1% may be used as an adjunct for the prevention and treatment of wound sepsis in patients with second-degree burns 3

Special Considerations

• When applying dressings on limbs, prevent bandages from creating a tourniquet effect 1
• Monitor distal perfusion in case of circular dressings 1
• Dressings should ideally be re-evaluated daily 1
• Topical antibiotics should not be used as first-line treatment but reserved for infected wounds only 1

When to Seek Medical Attention

• All burns involving the face, hands, feet, or genitals require immediate medical attention 1, 2
• Burns covering >10% body surface area in adults or >5% in children require medical evaluation 1
• All full-thickness burns require medical attention 1
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs) require immediate medical attention 1

Pitfalls to Avoid

• Do not use external cooling devices (e.g., Water-Jel dressings) for prolonged periods due to risk of hypothermia 1
• Do not apply butter, oil, or home remedies to burns as these can worsen tissue damage and increase infection risk 2
• Do not delay other resuscitation interventions for dressing application in severe burns 1
• Do not use routine antibiotic prophylaxis for burn patients unless infection is present 1
• Avoid using ice directly on burns as this can cause further tissue damage 2

Recent consensus from 2024 supports these recommendations, emphasizing the need for standardized approaches to second-degree burn management to improve outcomes 4, 5.