What topical treatments are recommended for burns?

Topical Treatments for Burns

For small partial-thickness burns managed at home, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera after cooling, then cover with a clean non-adherent dressing. 1

Initial Cooling (Before Any Topical Treatment)

• Cool the burn immediately with clean running water for 5-20 minutes to limit burn depth progression and reduce pain 1, 2, 3
• Remove jewelry before swelling occurs to prevent vascular compromise 1, 3
• Monitor children closely for hypothermia during cooling, especially with burns >10% body surface area 3

Topical Treatment by Burn Depth

Superficial (First-Degree) Burns

• Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera after cooling 1, 2, 3
• Cover with a clean, non-adherent dressing 2, 3
• These agents improve healing time compared to no dressing 1

Partial-Thickness (Second-Degree) Burns

For small burns managed at home:

• After cooling, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 3
• Cover with a non-adherent dressing 1, 3

For larger burns requiring medical attention:

• Clean with tap water, isotonic saline, or antiseptic solution 2, 3
• Apply a thin layer of petrolatum-based antibiotic ointment 3
• Cover with non-adherent dressing such as Xeroform, Mepitel, or Allevyn 3

Full-Thickness (Third-Degree) Burns

• After cooling, cover with a clean, dry, non-adherent dressing while awaiting medical care 3
• All full-thickness burns require immediate medical attention 2, 3

Important Cautions About Silver Sulfadiazine

Silver sulfadiazine should NOT be used as first-line treatment. Despite FDA approval for second and third-degree burns 4, evidence shows it is associated with:

• Significantly increased burn wound infection rates compared to dressings/skin substitutes (OR = 1.87) 5
• Prolonged hospital stays (average 2.11 days longer) 5
• Prolonged healing when used long-term on superficial burns 3

Silver sulfadiazine should be reserved for infected wounds only, not prophylaxis 2, 3, 6

Critical Pitfalls to Avoid

• Do not apply ice directly to burns - causes tissue ischemia and further damage 1, 2, 3
• Do not use topical antibiotics as first-line treatment - reserve for infected wounds only 2, 3, 6
• Do not routinely administer systemic antibiotic prophylaxis - no evidence of benefit and may increase MRSA 2, 5
• Do not break blisters - increases infection risk 3
• Do not apply butter, oil, or other home remedies 3
• When applying dressings on limbs, prevent tourniquet effect and monitor distal perfusion 2, 3, 6

When to Refer to Burn Center

Immediate medical attention required for: 1, 2, 3

• Burns involving face, hands, feet, or genitals
• Burns >10% body surface area in adults (>5% in children)
• All full-thickness burns
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs)

Pain Management

• Administer over-the-counter pain medications (acetaminophen or NSAIDs) for burn pain 1, 3
• Use multimodal analgesia with short-acting opioids and ketamine for severe burn-induced pain 2, 3