What is the recommended management for superficial second-degree burns using a clean non-adherent dressing?

Management of Superficial Second-Degree Burns with Non-Adherent Dressings

For superficial second-degree burns, apply a clean non-adherent dressing after proper wound cleansing and consider using a petrolatum-based antibiotic ointment underneath to promote healing and prevent infection. 1

Initial Management

• Immediately cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1
• Clean the wound with tap water, isotonic saline solution, or an antiseptic solution before applying any dressing 2
• Remove any jewelry from the affected area before swelling occurs to prevent constriction and vascular compromise 1, 3
• Administer appropriate pain medications such as acetaminophen or NSAIDs for pain management 1

Wound Assessment and Preparation

• Assess the depth and extent of the burn to confirm it is a superficial second-degree burn 4
• For intact blisters:
  • The detached epidermis may be left in situ to act as a biological dressing 2
  • Blisters should be decompressed by piercing and expression or aspiration of tissue fluid while preserving the blister roof 2, 5
• Do not break or pop blisters completely as this significantly increases infection risk 1, 3

Dressing Application

• Apply a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin over the burn area 2
• Consider using a petrolatum-based antibiotic ointment on the burn surface 1, 6
• Cover with a non-adherent dressing (suitable options include Mepitel™ or Telfa™) 2, 1
• Add a secondary foam or burn dressing to collect exudate if needed 2
• Ensure dressings on limbs do not create a tourniquet effect; monitor distal perfusion with circular dressings 2

Antimicrobial Considerations

• Apply topical antimicrobial agents only to sloughy areas, not to the entire burn surface 2
• Avoid using silver sulfadiazine for prolonged periods on superficial burns as it may be associated with prolonged healing 2, 3
• Routine systemic antibiotic prophylaxis is not recommended for superficial second-degree burns 2

Follow-up Care

• Ideally, dressings should be re-evaluated daily 2
• Monitor the burn for signs of infection such as increased pain, redness, swelling, or discharge 3
• Change dressings as needed, maintaining a clean environment during dressing changes 2

When to Refer to a Burn Specialist

• Burns involving the face, hands, feet, or genitalia require specialized care regardless of size 1, 5
• Burns covering >10% body surface area in adults (>5% in children) should be treated in a specialized burn center 1
• Consider referral if there are signs of infection, wound conversion, or delayed healing 2

Common Pitfalls to Avoid

• Do not apply ice directly to burns as this can cause further tissue damage 1, 5
• Do not apply butter, oil, or other home remedies to burns 3, 5
• Avoid using external cooling devices for prolonged periods to limit the risk of hypothermia 2
• Do not delay seeking medical attention for burns in sensitive areas or those covering large surface areas 1