What are the home care do's and don'ts for a mid to deep partial thickness burn wound on the face covering 1 percent of the Total Body Surface Area (TBSA)?

Home Care for Mid to Deep Partial Thickness Facial Burn (1% TBSA)

For a mid to deep partial thickness burn on the face covering 1% TBSA, immediately cool with clean running water for 20 minutes, then seek specialized burn center evaluation, as all facial partial-thickness burns require expert assessment regardless of size to optimize functional and cosmetic outcomes. 1, 2

Immediate DO's (First 20 Minutes)

Initial Cooling

• Cool the burn immediately with clean running water for 20 minutes to limit tissue damage, reduce pain, and improve healing outcomes 3, 1, 4
• Use tap water at approximately 15°C (cool tap water temperature) as this provides optimal benefit for deep partial thickness burns 5
• Remove any jewelry or tight items from the face/neck area before swelling occurs to prevent constriction 1, 6

Pain Management

• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain control 3, 1

After Cooling

• Loosely cover the burn with a clean, non-adherent dry dressing or clean cloth while awaiting medical evaluation 2, 6
• Monitor for signs of airway compromise including difficulty breathing, as facial burns can cause significant swelling 2
• Watch for signs of inhalation injury such as soot around the nose/mouth, singed nasal hairs, or breathing difficulty - these require immediate emergency services activation 2, 6

Critical DON'Ts

What NOT to Apply

• Do not apply ice directly to the burn as this causes further tissue damage 1, 6, 5
• Do not apply butter, oil, or other home remedies to the burn 1, 6
• Do not break any blisters as this significantly increases infection risk 1, 6
• Do not use external cooling devices (like Water-Jel dressings) for prolonged periods due to hypothermia risk 3

What NOT to Do

• Do not attempt home management without specialist evaluation - facial burns require specialized burn center care regardless of size 2
• Do not apply topical antibiotics as first-line treatment; these should be reserved for infected wounds only 3
• Do not delay seeking medical attention thinking the small size (1% TBSA) makes it minor - location on the face mandates specialist care 2

Why Specialist Evaluation is Mandatory

The American Burn Association recommends that all partial-thickness burns involving the face be treated in a specialized burn center regardless of size due to high risk of functional and cosmetic disability 2. Even though 1% TBSA is small, facial location creates special considerations:

• Risk of airway compromise from facial swelling 2
• High potential for cosmetic complications requiring specialized wound care 2
• Need for expert assessment of burn depth, which determines treatment approach 3
• Requirement for specialized dressings and daily monitoring that may need deep analgesia or general anesthesia 3

Proper Wound Care (If Specialist Directs Home Management)

If a burn specialist determines home management is appropriate after evaluation:

Cleaning and Dressing

• Clean the wound with tap water, isotonic saline, or antiseptic solution in a clean environment 3
• Apply petrolatum-based antibiotic ointment after cleaning 1
• Cover with non-adherent dressing such as Xeroform, Mepitel, or similar 1
• Re-evaluate dressings daily as recommended for optimal monitoring 3, 1

What to Avoid Long-Term

• Avoid prolonged use of silver sulfadiazine as it may prolong healing time in partial thickness burns 3
• Do not use routine antibiotic prophylaxis - antibiotics should only be used for confirmed infected wounds 3

Red Flags Requiring Immediate Medical Attention

• Signs of infection (increasing redness, warmth, purulent drainage, fever) 1, 6
• Increasing pain not controlled by over-the-counter medications 1, 6
• Difficulty breathing or swallowing 2, 6
• Signs of hypothermia if cooling was prolonged 3

Common Pitfall to Avoid

The most critical error is failing to recognize that facial burns require specialized care regardless of the small 1% TBSA size 2. Many patients and providers underestimate facial burns because the percentage seems minor, but location trumps size for facial partial-thickness burns in determining need for specialist evaluation 2.