What is the recommended management for superficial burns?

Management of Superficial Burns

For superficial burns, immediately cool with clean running water for 5-20 minutes, then apply a thin layer of petrolatum-based antibiotic ointment (bacitracin, Polysporin, or triple-antibiotic ointment) covered with a non-adherent dressing, and avoid silver sulfadiazine which prolongs healing. 1, 2, 1

Immediate Cooling

• Cool the burn immediately with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 3
• Monitor preadolescent children during cooling for signs of hypothermia, particularly with larger burns 1, 3
• If clean running water is unavailable, ice wrapped in cloth may be used for superficial burns with intact skin, though direct ice application should be avoided as it causes further tissue damage 1, 3
• Remove jewelry before swelling occurs to prevent constriction 3

Wound Cleaning

• Clean the burn with tap water, isotonic saline solution, or an antiseptic solution before applying any medication 1, 2
• Perform wound care in a clean environment 1, 3

Topical Treatment Selection

The critical decision here is avoiding silver sulfadiazine for superficial burns. The evidence strongly demonstrates that silver sulfadiazine is associated with prolonged healing when used on superficial burns, despite being historically considered standard treatment. 1, 2

Recommended Options:

• Apply a thin layer of petrolatum-based antibiotic ointment (bacitracin, Polysporin, or triple-antibiotic ointment) directly to the burn 2, 4
• Alternative acceptable options include petrolatum alone, honey, or aloe vera for small partial-thickness burns being managed at home 1, 3
• Preclinical evidence demonstrates that triple-antibiotic ointment enhances reepithelialization and reduces scarring compared to silver-based dressings 5

What to Avoid:

• Do not use silver sulfadiazine on superficial burns as it is associated with prolonged healing 1, 2
• Topical antibiotics should not be used as first-line prophylaxis but reserved for infected wounds only 1, 2
• Avoid butter, oil, or other home remedies 3, 4

Dressing Application

• Cover with a non-adherent dressing such as Xeroform (petrolatum-impregnated gauze) or Mepitel (silicone-coated dressing) 2, 4
• For burns with intact skin or intact blisters awaiting professional evaluation, loosely cover with a clean cloth or nonadherent dry dressing 1
• When applying dressings on limbs, prevent bandages from creating a tourniquet effect 1, 2
• Monitor distal perfusion with circular dressings 1, 3

Pain Management

• Administer over-the-counter pain medications (acetaminophen or NSAIDs) for pain control 1, 3
• For highly painful injuries or procedures, deeper analgesia or general anesthesia may be necessary 1, 3

Follow-Up Care

• Re-evaluate dressings daily 1, 2
• Monitor for signs of infection including increased pain, redness, swelling, or purulent discharge 2
• If infection develops, obtain wound cultures and consider alternative treatments 2

Indications for Immediate Medical Referral

Seek immediate medical care for:

• Burns involving the face, hands, feet, or genitalia 1, 2, 4
• Partial-thickness burns covering >10% body surface area (>5% in children) 1, 3
• Burns showing signs of infection 2, 4
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) 3

Common Pitfalls

• Do not apply ice directly to burns as this causes further tissue damage 2, 3, 4
• Do not break blisters as this increases infection risk 3
• External cooling devices should not be used for prolonged periods to avoid hypothermia 1, 3
• Routine systemic antibiotic prophylaxis is not recommended 1, 2