What is the proper treatment for burns?

Burn Treatment

Cool thermal burns immediately with room temperature tap water (15°C to 25°C) for 5-20 minutes as soon as possible after injury, and leave burn blisters intact to optimize healing and reduce pain. 1, 2

Immediate First Aid Management

Initial Cooling Protocol

• Apply room temperature tap water (15°C to 25°C) immediately within 30 minutes of injury to reduce pain, depth of injury, and need for grafting 1
• Continue cooling for 5-20 minutes to limit tissue damage 2, 3
• Never use ice or ice water as this increases tissue damage 1, 2
• Monitor children closely during cooling for hypothermia, especially with larger burns 1, 2
• Large burns should not be cooled without ability to monitor core temperature due to hypothermia risk 1

Additional Immediate Steps

• Remove jewelry from affected area before swelling occurs to prevent vascular compromise 2, 3
• Administer over-the-counter pain medications (acetaminophen or NSAIDs) 2, 3

Blister Management

Leave burn blisters intact - this is a critical recommendation based on evidence showing improved healing and reduced pain 1, 4

• Intact blisters serve as a biological dressing that helps with pain management and promotes healing 4
• Cover intact blisters loosely with clean, non-adherent dry dressing 3, 4
• Do not break or pop blisters as this significantly increases infection risk 3, 4

Topical Treatment by Burn Severity

Superficial (First-Degree) Burns

• After cooling, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 2, 4
• Cover with clean, non-adherent dressing 2, 3
• These burns heal without scarring and have low infection risk 2

Partial-Thickness (Second-Degree) Burns

• After cooling, apply petrolatum-based antibiotic ointment (such as triple antibiotic containing bacitracin, neomycin sulfate, and polymyxin B) 3, 4
• Cover with clean, non-adherent dressing 3, 4
• Silver sulfadiazine cream 1% may be applied once to twice daily to a thickness of approximately one-sixteenth inch, continued until satisfactory healing or until ready for grafting 5
• Avoid prolonged silver sulfadiazine use on superficial burns as it may delay healing 4

Full-Thickness (Third-Degree) Burns

• After cooling, cover with clean, dry, non-adherent dressing while awaiting medical care 2
• All full-thickness burns require immediate medical attention 2

When to Seek Immediate Medical Attention

Transfer to specialized burn care for:

• Burns involving face, hands, feet, or genitalia regardless of size 2, 3, 4
• Partial-thickness burns covering >10% body surface area in adults (>5% in children) 2, 3, 4
• All full-thickness (third-degree) burns 2
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) 2, 3
• Signs of infection 2, 3

Critical Pitfalls to Avoid

• Never apply ice directly to burns - causes further tissue damage 1, 2, 3, 4
• Never apply butter, oil, or other home remedies 2, 3
• Never break blisters - increases infection risk 3, 4
• Do not delay medical attention for burns in sensitive areas or covering large surface areas 3

Evidence Quality Note

The cooling recommendation is supported by 5 LOE 3 studies, 4 LOE 4 retrospective studies, and 28 LOE 5 animal experiments demonstrating reduced pain, depth of injury, and need for grafting 1. The blister management recommendation is based on 1 LOE 2 human study, 2 LOE 4 clinical studies, 1 LOE 5 volunteer study, and 4 LOE 5 animal studies 1. Immediate cooling has been shown to reduce the need for skin grafting by an estimated 32% 6.