Management of First-Degree Burns
For first-degree burns, applying petrolatum (Vaseline) alone is sufficient for treatment, with no dressing required unless the burn is in a high-friction area. 1, 2
Initial Management Steps
- Immediately cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 3, 2
- Remove any jewelry from the affected area before swelling occurs to prevent constriction 1, 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 4
- Monitor children closely for signs of hypothermia during cooling, especially with larger burns 1, 2
Treatment for First-Degree Burns
- After cooling, apply a thin layer of petrolatum (Vaseline) to the burn area 1, 2
- Other acceptable alternatives include petrolatum-based antibiotic ointment, honey, or aloe vera 1, 3
- For most first-degree burns, no dressing is required as these burns have intact skin and low infection risk 2
- If the burn is in an area prone to friction or irritation, a clean, non-adherent dressing may be applied 1
- Administer over-the-counter pain medications like acetaminophen or NSAIDs for pain control 1, 2
Why Petrolatum Alone Works for First-Degree Burns
- First-degree burns only affect the epidermis, generally heal without scarring, and have low infection risk 3, 5
- Petrolatum helps accelerate repair of the damaged skin barrier and reduces drying 5
- Aqueous emulsions with small amounts of well-tolerated lipids (O/W emulsions) are best suited for treating first-degree burns 5
- Water evaporates producing cooling and reducing inflammation, while the lipids help repair the skin barrier 5
Common Pitfalls to Avoid
- Do not apply ice directly to burns as this can cause further tissue damage 1, 3
- Do not apply butter, oil, or other home remedies to burns 1, 3
- Do not break blisters, as this increases infection risk 1, 3
- Avoid topical corticosteroids as superiority to the vehicle has not been shown 5
- Do not use silver sulfadiazine for superficial burns as it may be associated with prolonged healing 4
When to Seek Medical Attention
- Seek immediate medical care for burns that involve the face, hands, feet, or genitals 1, 2
- Seek immediate medical care for burns covering >10% body surface area in adults or >5% in children 2, 6
- Seek immediate medical care for burns showing signs of infection or that are very painful 1, 3
- Seek immediate medical care for burns with signs of inhalation injury (soot around nose/mouth, difficulty breathing) 3, 2