Treatment for Partial Thickness Burns
The recommended first-line treatment for partial thickness burns is immediate cooling with clean running water for 5-20 minutes, followed by application of a petrolatum-based antibiotic ointment and covering with a clean, non-adherent dressing. 1, 2, 3
Initial Management
- Immediately cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2, 3
- Remove any jewelry from the affected area before swelling occurs to prevent constriction and vascular ischemia 2, 3
- Monitor children closely for signs of hypothermia during cooling, especially with larger burns 2
- Administer over-the-counter pain medications like acetaminophen or NSAIDs for pain management 2, 3
Wound Care After Cooling
- Gently cleanse the burn with tap water or isotonic saline 4
- Apply a thin layer of petrolatum-based antibiotic ointment (such as bacitracin, Polysporin, or triple-antibiotic ointment) directly to the burn 4, 5
- Cover with a clean, non-adherent dressing such as:
- Clean gauze can be used as a secondary dressing over the non-adherent primary dressing 4
Evidence for Treatment Options
- Petrolatum gel alone has shown comparable or better results than silver sulfadiazine in terms of healing time (6.2 days vs 7.8 days) and was associated with less painful dressing changes 5
- Silver-containing foam dressings have shown no significant difference in wound healing compared to silver sulfadiazine with gauze, but may offer reduced pain during early treatment and potentially decreased infection rates 6
- Hydrocolloid dressings with silver sulfadiazine (Urgotul SSD) have demonstrated shorter healing times (10 days vs 12 days) and significantly lower pain scores compared to traditional silver sulfadiazine dressings 7
- Bioengineered skin substitutes have shown significant improvements in healing rate, decreased wound care time, and reduced pain compared to topical antibiotics for facial burns 8
Important Considerations and Pitfalls
- Avoid applying ice directly to burns as this can cause further tissue damage 4, 2
- Do not apply butter, oil, or other home remedies to burns 4, 2
- Do not break blisters, as this increases infection risk 2
- Be aware that silver sulfadiazine may cause transient leukopenia, skin necrosis, erythema multiforme, and delayed eschar separation 9
- Mafenide acetate can cause metabolic acidosis due to carbonic anhydrase inhibition and should be used with caution in patients with renal dysfunction 10
When to Seek Medical Attention
- Burns involving the face, hands, feet, or genitalia 4, 2, 3
- Burns covering more than 10% body surface area (5% in children) 4, 2, 3
- Burns that show signs of infection or are very painful 4, 2
- Burns with signs of inhalation injury (soot around nose/mouth, difficulty breathing) 2, 3
- All full-thickness (third-degree) burns 2
The American Burn Association recommends that patients with partial-thickness burns involving more than 10% body surface area be treated in a specialized burn center 3.