What is the proper treatment for skin burns?

Skin Burn Treatment

Immediately cool the burn with clean running water for 5-20 minutes, remove jewelry before swelling occurs, apply petrolatum-based ointment or honey after cooling, cover with a non-adherent dressing, and give over-the-counter pain medication. 1

Immediate First Aid (First 20 Minutes)

Active cooling is the single most important initial intervention:

• Cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2
• This decreases the need for subsequent medical care and reduces burn depth 1
• For adults with burns <20% total body surface area (TBSA) and children <10% TBSA, cooling should be performed unless shock is present 1, 2
• Critical pitfall: Monitor children closely for hypothermia during cooling, especially with larger burns 2

Remove constricting items immediately:

• Remove all jewelry from the affected area before swelling begins to prevent vascular ischemia 1, 2

Pain Management

Over-the-counter analgesics are first-line:

• Give acetaminophen or NSAIDs (such as ibuprofen 800mg every 6 hours) for burn pain 1, 2
• These medications are well-tolerated and generally recommended 1

Wound Care After Cooling

For Small Partial-Thickness Burns (Managed at Home):

• Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera to open burn wounds 1, 2
• Cover with a clean, non-adherent dressing 1, 2
• These agents improve healing time compared to no dressing 1

For Burns with Intact Skin or Intact Blisters:

• Loosely cover with a clean cloth or non-adherent dry dressing while awaiting medical evaluation 1, 2
• This protects the wound and reduces pain without trapping heat 1

For Larger Burns Requiring Medical Care:

• Clean wounds with tap water, isotonic saline, or antiseptic solution before dressing 1, 2
• Apply appropriate dressing based on TBSA and wound appearance 1, 2
• When applying dressings on limbs, prevent tourniquet effect and monitor distal perfusion 1, 2
• Re-evaluate dressings daily 1, 2

Critical Pitfalls to Avoid

Do NOT do the following:

• Do not apply ice directly to burns—this causes further tissue damage 2, 3
• Do not apply butter, oil, or other home remedies 2, 3
• Do not break blisters—this increases infection risk 2, 3
• Do not use external cooling devices (Water-Jel dressings) for prolonged periods due to hypothermia risk 1, 2
• Do not use topical antibiotics as first-line treatment—reserve for infected wounds only 1, 2
• Do not give routine antibiotic prophylaxis 1, 2

Special consideration for silver sulfadiazine:

• While silver sulfadiazine is widely used for partial-thickness burns 4, 5, it may prolong healing if used long-term on superficial burns 1, 2
• Apply once to twice daily to a thickness of approximately one-sixteenth inch if used 4

When to Seek Immediate Medical Care

Transfer to specialized burn center for:

• Burns involving face, hands, feet, genitals, or perineum—these require surgical intervention to prevent permanent disability 1, 2, 6
• Partial-thickness burns >10% body surface area in adults (>5% in children) 1, 2
• All full-thickness (third-degree) burns 2, 3
• Signs of inhalation injury: facial burns, difficulty breathing, singed nasal hairs, or soot around nose/mouth 1, 2, 6
• Burns showing signs of infection 2, 3

Rationale for specialized care: Burns involving critical areas may need intravenous fluid resuscitation, surgery, and specialized treatments that only burn centers can provide 1. Inhalation injury can rapidly lead to airway loss from swelling and may indicate carbon monoxide poisoning 1.