What are the treatment options for thermal burns?

From the Guidelines

Treatment for burns should always start with immediate cooling using running water, as it is an established and beneficial intervention with little risk of harm, as suggested by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The goal of burn treatment is to reduce pain, prevent further damage, and promote healing.

Key Steps in Burn Treatment

• Cool the burn with running water for 10-15 minutes to stop the burning process and reduce pain, as recommended by the guidelines 1.
• After cooling, apply a thin layer of petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera to keep the area moist and protect it, as suggested by the guidelines 1.
• Cover the burn with a clean, non-stick bandage or cloth to protect the wound and reduce pain, as recommended by the guidelines 1.
• Take over-the-counter pain relievers like acetaminophen or ibuprofen as needed for pain, as suggested by the guidelines 1.

Important Considerations

• Never use ice, as it can damage tissue further, as warned by the guidelines 1.
• For more serious burns (large second-degree or any third-degree burns), seek immediate medical attention, as they require professional medical treatment including specialized dressings, antibiotics, and possibly skin grafting.
• Proper care reduces infection risk and promotes healing, and burns heal better in a moist environment, as suggested by the guidelines 1.

From the FDA Drug Label

Prompt institution of appropriate regimens for care of the burned patient is of prime importance and includes the control of shock and pain. The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions. The cream should be applied once to twice daily to a thickness of approximately one sixteenth of an inch. Treatment with silver sulfadiazine cream, USP 1% should be continued until satisfactory healing has occurred or until the burn site is ready for grafting.

The treatment for burn includes:

• Cleansing and debridement of the burn wounds
• Application of silver sulfadiazine cream, USP 1% under sterile conditions
• Daily application of the cream, once to twice a day, to a thickness of approximately one sixteenth of an inch
• Continuation of treatment until satisfactory healing has occurred or until the burn site is ready for grafting 2

From the Research

Treatment for Burn Wounds

• The primary goal of treating burn wounds is to prevent infection and promote healing. According to 3, topical antimicrobial agents play a crucial role in preventing burn wound infections.
• The choice of topical therapy depends on the depth of the burn, with superficial burns requiring optimization of re-epithelialization and deep burns requiring minimization of microbial growth until the wound is grafted 4.
• Topical antimicrobial agents, such as creams and ointments, have been commonly used in burn care for many years 5.
• However, the use of certain topical antimicrobial agents, such as silver sulfadiazine, has been associated with an increased risk of burn wound infection and longer hospital stays 6.
• Systemic antibiotic prophylaxis has been shown to have no significant effect on rates of burn wound infection in non-surgical patients, but may be effective in reducing pneumonia in certain cases 6.
• The use of antibiotics in burn patients should be carefully managed to avoid misuse and promote effective treatment, taking into account factors such as bactericidia, combination, adaptation, de-escalation, and treatment duration 7.

Types of Topical Antimicrobial Agents

• Antimicrobial creams and ointments, such as those containing silver or iodine, have been widely used in burn care 3, 5.
• Antimicrobial solutions, such as those containing antibiotics or antbores, may be used as adjuncts to surgical intervention 3.
• Antimicrobial dressings, which are an ever-advancing roster of products, may be used to promote wound closure and prevent infection 3.

Considerations for Burn Wound Treatment

• The development of effective topical antimicrobial agents has been a major advance in burn care, but many gaps in treatment remain, particularly for complicated burn wounds 5.
• Fungal infections, impaired wound healing, and advanced age or medical comorbidities may require special consideration in burn wound treatment 5.
• Research on optimal topical treatment continues, with a focus on minimizing aggressive wound excision and disfiguring donor tissue collection while securing rapid wound closure 3.