How to manage superficial second-degree burns?

Management of Superficial Second-Degree Burns

For superficial second-degree burns, immediately cool the burn with clean running water for 5-20 minutes, then apply petrolatum-based ointment and cover with a clean non-adherent dressing. 1, 2, 3

Initial Management

• Immediately cool the burn with clean running water (15-25°C) for 5-20 minutes to limit tissue damage and reduce pain 1, 2, 4
• Remove any jewelry from the affected area before swelling occurs to prevent constriction and vascular ischemia 2, 3
• For adults with burns covering <20% of total body surface area (TBSA) and children with <10% TBSA, cooling should be performed in the absence of shock 1, 4
• Monitor children closely for signs of hypothermia during cooling, especially with larger burns 2, 3
• Do not apply ice directly to burns as this can cause further tissue damage; if using ice, ensure it is wrapped in cloth 1, 2

Wound Cleaning and Assessment

• Clean the burn wound with tap water, isotonic saline solution, or an antiseptic solution in a clean environment 1, 4
• Assess the burn for size, depth, and location to determine appropriate management 3
• Note that burns involving face, hands, feet, genitals, or >10% body surface area (>5% in children) require specialized burn center treatment 1, 2

Dressing Application

• After cooling, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera to the burn wound 1, 2, 3
• Cover with a clean non-adherent dressing such as Xeroform or Mepitel 2, 3
• When applying dressings on limbs, prevent bandages from creating a tourniquet effect 3, 4
• Monitor distal perfusion in case of circular dressings 3, 4
• Ideally, dressings should be re-evaluated daily 3, 4

Pain Management

• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain control 1, 3
• For more severe pain, short-acting opioids and ketamine are effective for managing burn-induced pain 1, 4
• Non-pharmacological treatments such as cooling limited burned surfaces and covering burns with appropriate dressings may improve pain control 1, 4

Special Considerations

• Topical antibiotics should not be used as first-line treatment but reserved for infected wounds only 3, 4
• Silver sulfadiazine may be associated with prolonged healing if used for a long time on superficial burns and should be avoided for superficial partial-thickness burns 1, 4
• Do not break blisters, as this increases infection risk 2
• Avoid applying butter, oil, or other home remedies to burns 2

When to Seek Medical Attention

• Seek immediate medical care for burns that involve the face, hands, feet, or genitals 1, 2, 3
• Seek immediate medical care for partial-thickness burns covering >10% body surface area (>5% in children) 1, 2, 3
• Seek immediate medical care for all full-thickness (third-degree) burns 2, 3
• Seek immediate medical care for burns showing signs of infection or that are very painful 2, 3
• Seek immediate medical care for burns with signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs) 1, 3