Are blisters removed in second-degree partial thickness burns?

Management of Blisters in Second-Degree Partial Thickness Burns

Blisters in second-degree partial thickness burns should generally not be removed but rather kept intact and loosely covered with a clean cloth or nonadherent dry dressing while awaiting evaluation by a healthcare professional. 1

Initial Management of Partial Thickness Burns

• Immediately cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2
• Remove any jewelry from the affected area before swelling occurs to prevent constriction and vascular compromise 1, 2
• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain management 1

Blister Management

• Do not break or remove blisters in second-degree partial thickness burns as this significantly increases infection risk 2
• Intact blisters serve as a natural biological dressing that protects the wound 3
• After cooling, loosely cover a burn that has intact skin or an intact blister with a clean cloth or nonadherent dry dressing 1
• If a blister needs to be managed, the current recommendation is to puncture it in a sterile way while keeping the overlying skin as a biological cover 3

Rationale for Preserving Blisters

• Burn blister fluid contains proteins such as immunoglobulins, various cytokines, prostaglandins, and interleukins that may play a role in the healing process 3
• Keeping blisters intact reduces the risk of infection by maintaining a natural barrier 2, 4
• Preserving the blister roof as a biological dressing helps with pain management and promotes healing 1

Proper Technique for Blister Management (If Necessary)

If blisters need to be decompressed (typically done by healthcare professionals):

• Gently cleanse blister with antimicrobial solution, taking care not to rupture it 1
• Pierce blister at base with a sterile needle, with the bevel facing up 1
• Select a site where fluid will drain out by gravity to discourage refilling 1
• Gently apply pressure with sterile gauze swabs to facilitate drainage 1
• Do not deroof the blister 1, 2
• After fluid has drained, gently cleanse again with an antimicrobial solution 1

When to Seek Medical Attention

• Burns involving the face, hands, feet, and genitals require specialized care regardless of size 1, 5
• Burns covering >10% body surface area (5% in children) should be treated in a specialized burn center 1, 6
• Signs of infection such as increased pain, redness, swelling, or discharge require immediate medical attention 2

After Blister Management

• For small partial-thickness burns being managed at home, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera and a clean nonadherent dressing to open burn wounds 1
• The application of a bland emollient, such as 50% white soft paraffin and 50% liquid paraffin, is recommended to support barrier function and encourage re-epithelialization 1
• Monitor for signs of infection, which is a significant risk and major cause of mortality in burn patients 1

Common Pitfalls to Avoid

• Do not apply ice directly to burns as this can cause further tissue damage 2, 5
• Do not apply butter, oil, or other home remedies to burns 2, 5
• Avoid using silver sulfadiazine for prolonged periods on superficial burns as it may delay healing 2
• Do not delay seeking medical attention for burns in special areas (face, hands, feet, genitals) 1, 5