Treatment for First-Degree Burns
Immediately cool the burn with clean running water for 5-20 minutes, then apply petrolatum-based ointment or aloe vera, cover with a non-adherent dressing, and use over-the-counter pain medications. 1, 2
Immediate Cooling (First Priority)
- Cool the burn immediately with clean running water for 5-20 minutes to limit burn progression and reduce pain 1, 2
- This cooling duration is supported by international consensus showing that adequate cooling (≥10 minutes) reduces hospital admission rates and burn depth 3
- If clean running water is unavailable, superficial burns with intact skin may be cooled with ice wrapped in cloth (never apply ice directly to skin) 1, 2
- Remove jewelry before swelling occurs to prevent constriction and vascular ischemia 1, 2
Important caveat: Monitor children closely for hypothermia during cooling, especially preadolescent children with larger burns 1, 2. The guidelines do not specify exact thresholds, but cooling should be limited in burns covering >5% body surface area in children 2.
Post-Cooling Wound Care
After cooling, the wound care approach is straightforward:
- Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera to the burn surface 1, 2
- Cover loosely with a clean, non-adherent dry dressing 1, 2
- Aqueous emulsions with small amounts of lipids (oil-in-water emulsions) are particularly well-suited, as water evaporates to provide cooling while lipids accelerate barrier repair 4
Common pitfall to avoid: Do not apply butter, oil, or other home remedies, as these can trap heat and worsen tissue damage 2. Topical corticosteroids are not recommended, as they have not shown superiority over vehicle alone 4.
Pain Management
- Use over-the-counter pain medications such as acetaminophen or NSAIDs for burn pain 1, 2
- These are sufficient for first-degree burns, which involve only the epidermal layer 5
When to Seek Medical Attention
First-degree burns generally heal without scarring and have low infection risk 1, but seek medical care if:
- Burns involve the face, hands, feet, or genitals 1, 2
- Burns cover >10% body surface area in adults or >5% in children 1, 2
- Signs of inhalation injury are present (soot around nose/mouth, difficulty breathing, singed nasal hairs) 1, 2
- Signs of infection develop (increased pain, redness extending beyond burn margin, purulent discharge) 2, 6
Evidence Quality Note
The recommendation for active cooling is based on a strong consensus despite low-quality evidence 3. The task force prioritized decreased burn depth over potential risks of infection or hypothermia. Research shows that immediate cooling reduces the percentage of burns requiring skin grafting by an estimated 32% 7, though one controlled study found that cooling at 8°C for 30 minutes did not reduce hyperalgesia compared to placebo 8. The practical benefit lies in preventing progression to deeper burns rather than pain relief alone.