What is the treatment for a second-degree burn?

Treatment for Second-Degree Burns

The treatment for second-degree burns should begin with immediate cooling with clean running water for 5-20 minutes to limit burn progression and reduce pain, followed by appropriate dressing application based on burn severity, location, and size. 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
• Remove jewelry before swelling occurs to prevent constriction and vascular ischemia 1
• Monitor children closely for signs of hypothermia during cooling, especially preadolescent children 1, 2
• 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
• Silver sulfadiazine cream 1% is indicated as an adjunct for prevention and treatment of wound sepsis in second and third-degree burns 3
• Triple-antibiotic ointment has been shown to enhance reepithelialization and reduce scar depth compared to silver-based foam dressings 4

Special Considerations for Hand Burns

• Hand burns require immediate cooling with clean running water for 5-20 minutes 2
• Partial or full-thickness hand burns require evaluation at a specialized burn center 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 immediately 2

Wound Management Precautions

• When applying dressings on limbs, prevent bandages from creating a tourniquet effect 1
• Monitor distal perfusion in case of circular dressings 1
• Ideally, dressings should 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
• All full-thickness burns require medical attention 1
• Burns covering >10% body surface area in adults or >5% in children 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 delay other resuscitation interventions for dressing application in severe burns 1
• Avoid routine antibiotic prophylaxis for burn patients unless infection is present 1
• Do not use ice directly on burns, apply butter or oil, or delay referral for partial or full-thickness burns 2