What is the treatment for a second-degree burn?

Treatment of Second-Degree Burns

The immediate treatment for second-degree burns involves cooling the burn with clean running water for 5-20 minutes, followed by application of appropriate dressings and referral to specialized care for burns involving critical areas or covering >10% body surface area in adults or >5% in children. 1

Immediate First Aid Steps

• Cool the burn immediately with clean running water for 5-20 minutes to limit burn depth progression and reduce pain 1
• Monitor children closely for signs of hypothermia during cooling 1, 2
• Remove all jewelry before swelling occurs to prevent constriction and vascular ischemia 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
• Second-degree burns are partial-thickness burns that may be superficial (involving epidermis and superficial dermis) or deep (extending into deeper dermis) 2, 3

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
• Silver sulfadiazine cream 1% is indicated as an adjunct for prevention and treatment of wound sepsis in second and third-degree burns 4
• Triple-antibiotic ointment has been shown to enhance reepithelialization and reduce scar depth compared to silver-based foam dressings in research studies 5

Special Considerations for Hand Burns

• Hand burns require specialized care due to high risk of functional disability 2
• For partial-thickness hand burns, loosely cover with a clean, non-adherent dressing and refer to a burn specialist or burn center immediately 2
• Monitor for signs of compartment syndrome in circumferential burns 2

When to Seek Medical Attention

• Burns involving the face, hands, feet, or genitals require immediate medical attention 1, 2
• All full-thickness burns require medical attention 1
• Burns covering >10% body surface area in adults or >5% in children require medical evaluation 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 ice directly on burns as it may cause further tissue damage 2
• Do not apply butter or oil to burns 2
• Do not use external cooling devices (e.g., Water-Jel dressings) for prolonged periods due to risk of hypothermia 1
• Avoid routine antibiotic prophylaxis for burn patients unless infection is present 1
• Do not delay referral for partial or full-thickness burns in critical areas as this can lead to permanent functional impairment 2

Dressing Changes and Follow-up

• Ideally, dressings should be re-evaluated daily to monitor healing progress 1
• When applying dressings on limbs, prevent bandages from creating a tourniquet effect 1
• Monitor distal perfusion in case of circular dressings 1
• The most recent consensus (2024) emphasizes the importance of standardized approaches to second-degree burn management to improve outcomes 3, 6