What is the treatment for a second-degree burn?

Treatment of Second-Degree Burns

The recommended treatment for second-degree burns includes immediate cooling with clean running water for 5-20 minutes, followed by application of a non-adherent dressing, with silver sulfadiazine cream being indicated for prevention and treatment of wound sepsis. 1, 2

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
• Consider over-the-counter pain medications (acetaminophen or NSAIDs) for pain management 1
• Monitor children closely for signs of hypothermia during cooling 1, 3
• If clean running water is not available, superficial burns with intact skin may be cooled with ice wrapped in cloth (never apply ice directly to the burn) 1, 3

Wound Assessment and Cleaning

• Clean the wound with tap water, isotonic saline, or an antiseptic solution 1
• Assess the burn for size, depth, and location to determine appropriate management 1
• Perform wound care in a clean environment with appropriate pain control 1
• Burns involving face, hands, feet, genitals, or >10% body surface area (>5% in children) require specialized burn center treatment 1, 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 1
• For prevention and treatment of wound sepsis, silver sulfadiazine cream 1% can be applied to a thickness of approximately 1/16 inch once to twice daily 2
• When using silver sulfadiazine, the cream should be reapplied to any areas from which it has been removed by patient activity 2
• Reapply silver sulfadiazine immediately after hydrotherapy 2
• When applying dressings on limbs, prevent bandages from creating a tourniquet effect 1
• Monitor distal perfusion in case of circular dressings 1

Special Considerations for Hand Burns

• Hand burns require immediate cooling with clean running water to limit tissue damage 3
• Partial or full-thickness hand burns require evaluation at a specialized burn center due to high risk of functional disability 3
• For partial-thickness hand burns, loosely cover with a clean, non-adherent dressing and refer to a burn specialist immediately 3

When to Seek Medical Attention

• Burns involving the face, hands, feet, or genitals require immediate medical attention 1, 3
• 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

Treatment Duration and Follow-up

• Treatment with silver sulfadiazine cream should be continued until satisfactory healing has occurred or until the burn site is ready for grafting 2
• Dressings should ideally be re-evaluated daily 1
• The drug should not be withdrawn while there remains the possibility of infection except if a significant adverse reaction occurs 2

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 apply butter or oil to burns, as this can lead to further damage 3
• Do not delay referral for partial or full-thickness burns involving functional areas like hands 3