What is the first-line treatment for a first-degree burn?

First-Line Treatment for First-Degree Burns

Immediately cool the burn with clean running water (15-25°C) for 5-20 minutes, then apply petrolatum or petrolatum-based antibiotic ointment and cover with a clean, non-adherent dressing. 1, 2

Immediate Cooling (First Priority)

The most critical first-line intervention is prompt cooling to limit tissue damage and reduce pain:

• Apply clean running water at 15-25°C for 5-20 minutes as soon as possible after injury 3, 1, 2
• Cooling is effective up to 3 hours post-injury and reduces pain, edema, depth of injury, and speeds healing 3, 4
• If running water is unavailable, ice wrapped in cloth may be used for superficial burns with intact skin 2
• Remove jewelry immediately before swelling occurs to prevent constriction and vascular compromise 1, 2

Critical Cooling Precautions:

• Never apply ice directly to the burn as this causes tissue ischemia and further damage 3, 1
• Monitor children closely for hypothermia during cooling, especially with larger burns 1, 2

Post-Cooling Topical Treatment

After adequate cooling, the next step is topical therapy:

• Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera to the cooled burn 1, 2
• Aqueous emulsions with small amounts of lipids (O/W emulsions) are ideal as water evaporates to provide cooling while lipids repair the damaged skin barrier 5
• Foam sprays and lotions are particularly well-suited because they are easy and painless to apply 5

Dressing Application

• Cover loosely with a clean, non-adherent dressing after applying topical treatment 1, 2
• The dressing protects the wound while allowing it to heal 1

Pain Management

• Administer over-the-counter acetaminophen or NSAIDs for pain control 1, 2
• These are sufficient for first-degree burns which only involve the epidermal layer 6

What NOT to Do (Common Pitfalls)

• Do not apply butter, oil, or other home remedies as these can worsen injury 1
• Do not use topical corticosteroids as superiority to vehicle has not been demonstrated 5
• Do not break blisters if any form, as this increases infection risk 1
• Do not use prophylactic antibiotics - these are not indicated and may increase bacterial resistance 4, 6

When to Seek Medical Attention

First-degree burns generally heal without scarring and have low infection risk 2, but seek immediate care for:

• Burns involving the face, hands, feet, or genitals 1, 2
• Burns covering >10% body surface area in adults or >5% in children 1, 2
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs) 2
• Burns showing signs of infection or that are very painful 1