What is the recommended treatment for first and second degree burns?

Treatment of First and Second Degree Burns

The recommended treatment for first and second degree burns is immediate cooling with clean running water for 5-20 minutes, followed by appropriate dressing based on burn severity. 1, 2

Initial Management for All Burns

• Immediately cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 3, 1
• Remove any jewelry from the affected area before swelling occurs to prevent constriction 1
• For adults with burns covering <20% of total body surface area (TBSA) and children with <10% TBSA, cooling should be performed while monitoring for hypothermia 1
• Do not apply ice directly to burns as this can cause further tissue damage 1, 4
• Do not apply butter, oil, or other home remedies to burns 1

Treatment Based on Burn Severity

First-Degree Burns (Superficial)

• After cooling, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 2
• Cover with a clean, non-adherent dressing 2
• Administer over-the-counter pain medications like acetaminophen or NSAIDs for pain control 2
• O/W emulsions (water-based with small amounts of lipids) are particularly effective for first-degree burns as they provide cooling through water evaporation while lipids help repair the skin barrier 5
• Foam sprays and lotions are ideal because they are easy and painless to apply 5

Second-Degree Burns (Partial-Thickness)

• After cooling, clean the wound with tap water, isotonic saline, or an antiseptic solution 1, 6
• Apply a thin layer of petrolatum-based antibiotic ointment 1
• Cover with a non-adherent dressing such as paraffin gauze, Xeroform, Mepitel, or Allevyn 1, 6
• Monitor dressings and change based on wound condition, typically every 1-2 days 6
• Avoid using silver sulfadiazine for prolonged periods on superficial burns as it may delay healing 1, 6

Pain Management

• Use multimodal analgesia with medications titrated based on validated comfort and analgesia assessment scales 1
• Over-the-counter pain medications such as acetaminophen or NSAIDs are recommended for mild burn pain 2
• For severe burn-induced pain, short-acting opioids and ketamine may be effective 1

When to Seek Medical Attention

• Burns involving the face, hands, feet, or genitals 1, 2
• Partial-thickness burns covering >10% body surface area in adults or >5% in children 1, 6
• All full-thickness (third-degree) burns 1
• Burns showing signs of infection or that are very painful 1
• Burns with signs of inhalation injury (soot around nose/mouth, difficulty breathing) 1, 2

Evidence Quality and Considerations

The recommendation for cooling burns with water is supported by strong evidence. A 2015 international consensus guideline strongly recommends active cooling of thermal burns, despite the low quality of evidence 3. The optimal temperature appears to be around 15°C (cool tap water), as demonstrated in animal studies showing better outcomes in terms of reepithelialization, scar histology, and appearance compared to ice or extremely cold water 4.

While some older research questioned the anti-hyperalgesic effects of cooling 7, more recent guidelines consistently recommend it as an essential first step 1, 2, 6. The cooling duration of 5-20 minutes is widely accepted, though the optimal duration remains a knowledge gap 3.

For dressings, non-adherent options are preferred for both first and second-degree burns 1, 6. For second-degree burns, paraffin gauze creates a protective barrier while allowing exudate to pass through 6.

It's important to note that inappropriate initial treatment or delay may adversely affect subsequent treatment and healing 8, highlighting the importance of prompt and appropriate first aid for burns.