What is the recommended topical ointment, such as MEBO (Moist Exposed Burn Ointment), for treating burn injuries?

Recommended Topical Ointments for Burn Injuries

For partial-thickness burns managed at home, apply petrolatum-based antibiotic ointment, plain petrolatum, medical-grade honey, or aloe vera covered with a clean non-adherent dressing. 1, 2, 3

Initial Cooling (Before Any Ointment Application)

• Cool the burn immediately with clean running water (15-25°C) for 5-20 minutes to limit tissue damage and reduce pain 1, 2, 3
• This cooling step must precede any dressing or ointment application 1
• Avoid cooling large burns (>20% TBSA in adults, >10% in children) due to hypothermia risk 1

Recommended Topical Agents by Burn Severity

Superficial (First-Degree) Burns:

• Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 2
• Cover with clean, non-adherent dressing 2

Partial-Thickness (Second-Degree) Burns:

• Apply a thin layer of petrolatum-based antibiotic ointment 2
• Alternative options include plain petrolatum, medical-grade honey, or aloe vera 1, 3
• Cover with non-adherent dressing such as Xeroform, Mepitel, or Allevyn 2

Full-Thickness (Third-Degree) Burns:

• Cover with clean, dry, non-adherent dressing while awaiting immediate medical care 2
• All full-thickness burns require emergency medical attention 2

Silver Sulfadiazine: When and How to Use

Silver sulfadiazine is FDA-approved for prevention and treatment of wound sepsis in second and third-degree burns 4, but current guidelines suggest it should not be first-line for simple partial-thickness burns.

Application technique (if used):

• Apply to thickness of approximately 1/16 inch once to twice daily 4
• Apply under sterile conditions after wound cleansing and debridement 4
• Reapply immediately after hydrotherapy 4

Important caveats:

• Avoid prolonged use on superficial burns as it may delay healing 1, 2
• Silver sulfadiazine forms an overlying slough that makes wound assessment difficult 5
• Topical antibiotics should be reserved for infected wounds only, not used as first-line treatment 1, 2, 3

MEBO (Moist Exposed Burn Ointment): The Evidence

While MEBO has been studied as an alternative to silver sulfadiazine, the evidence does not support its superiority over conventional treatments:

• One study showed MEBO did not demonstrate statistical advantage over petroleum jelly or silver sulfadiazine for wound healing rate or bacterial control 6
• MEBO is particularly unsuitable for deep burn wounds when infection is a concern 6
• For facial burns, MEBO showed similar healing rates to silver sulfadiazine, with the advantage of easier wound assessment due to minimal slough formation 5
• A 2012 study found no statistically significant difference in transepidermal water loss between MEBO and Flammazine (p=0.78) 7

Given this equivocal evidence and the availability of well-established alternatives, MEBO cannot be recommended over standard petrolatum-based products or honey.

Critical Pitfalls to Avoid

• Never apply butter, oil, or other home remedies to burns 2
• Do not apply ice directly to burns as this causes tissue damage 1, 2
• Do not use topical antibiotics routinely on uninfected wounds to prevent antimicrobial resistance 1, 2, 3
• Do not break blisters as this increases infection risk 2
• Avoid external cooling devices (Water-Jel dressings) for prolonged periods due to hypothermia risk 1, 3

When to Seek Immediate Medical Care

• Burns involving face, hands, feet, or genitals 1, 2, 3
• Partial-thickness burns >10% TBSA in adults or >5% in children 1, 2, 3
• All full-thickness burns 2, 3
• Signs of infection (increasing pain, redness, swelling, purulent discharge) 1
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) 2, 3