What is the proper way to cover a burn with skin peeling off?

How to Cover a Burn with Skin Peeling Off

After cooling the burn with clean running water for at least 10 minutes, loosely cover it with a sterile, dry, non-adherent dressing while leaving any intact blistered skin in place—do not remove the peeling skin as it serves as a natural biological dressing that improves healing and reduces pain.

Initial Cooling (First Priority)

• Cool the burn immediately with cool or cold potable water (15-25°C) for at least 10 minutes to reduce pain, edema, and depth of injury 1
• Continue cooling until pain is relieved, as this speeds healing and may reduce the need for skin grafting 1
• Avoid applying ice directly to the burn, as it can cause tissue ischemia and further damage 1, 2
• Monitor for hypothermia when cooling large burns (>20% body surface area in adults, >10% in children) 1

Managing Peeling Skin and Blisters

• Leave intact blisters and peeling skin in place—do not remove the detached epidermis as it acts as a natural biological dressing that improves healing and reduces pain 1, 2
• If blisters are tense or large, decompress them by piercing and expressing fluid while preserving the blister roof 2
• The American College of Surgeons specifically advises against breaking or popping blisters completely, as this significantly increases infection risk 2

Dressing Application

• Apply a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin over the burn area before covering 2
• Alternatively, use a petrolatum-based antibiotic ointment on the burn surface 2
• Cover loosely with a sterile, non-adherent dressing such as Mepitel or Telfa 1, 2, 3
• The dressing should be clean and dry, protecting the wound while maintaining a moist healing environment 1, 3

What NOT to Do (Critical Pitfalls)

• Never apply butter, oil, honey, potato peels, or other home remedies in typical first aid settings 1, 2
• Do not use tight or adherent dressings that will stick to the wound 2
• Avoid prolonged use of silver sulfadiazine on superficial burns, as it may delay healing 2
• Do not apply topical antimicrobials to the entire burn surface—only to sloughy areas if needed 2

When to Seek Immediate Medical Care

• Burns with blistering or broken skin require healthcare evaluation 1
• Burns involving the face, neck, hands, feet, or genitals need specialized care regardless of size 1, 2
• Burns covering >10% body surface area in adults (>5% in children) require burn center treatment 2, 3
• Any burn causing difficulty breathing, or signs of infection (increased pain, redness, swelling, discharge) needs immediate evaluation 1, 2

Follow-Up Care

• Re-evaluate dressings daily and change as needed while maintaining a clean environment 2
• Monitor for signs of infection or delayed healing 2
• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain management 2, 3