Partial Thickness Burn Treatment and Dressing Management
Immediate First Aid
Immediately cool partial thickness burns with clean running water for 5-20 minutes to limit tissue damage and reduce pain. 1, 2, 3, 4
- Remove all jewelry from the affected area before swelling occurs to prevent vascular compromise 2, 3, 4
- Administer acetaminophen or NSAIDs for pain control 2, 3, 4
- Never apply ice directly to burns, as this causes additional tissue damage 2, 3
- Avoid butter, oils, or other home remedies 2
Blister Management
Preserve intact blisters as a biological dressing to reduce infection risk and promote healing. 3
- Cover intact blisters loosely with a clean, non-adherent dry dressing 3
- The blister roof serves as a natural barrier that helps with pain management and healing 3
- Do not rupture blisters, as this increases infection risk 2
Wound Dressing Selection After Cooling
After initial cooling, apply a non-adherent dressing or topical antimicrobial agent rather than silver sulfadiazine for optimal healing outcomes. 5, 6
Preferred Options:
- Triple-antibiotic petrolatum-based ointment with non-adherent dressing changes 3 times weekly 6
- Honey dressings (superior infection resolution and faster healing than silver sulfadiazine) 1
- Hydrogel dressings (faster healing than usual care) 5
- Biosynthetic or silicon-coated dressings (better healing than silver sulfadiazine) 5
- Petrolatum or bland emollient with non-adherent dressing 3
Silver Sulfadiazine Limitations:
- Silver sulfadiazine is FDA-approved and remains standard treatment 7, but consistently shows poorer healing outcomes compared to biosynthetic dressings, silver-containing dressings, and silicon-coated dressings 5
- If used, apply once to twice daily at 1/16 inch thickness until healing occurs 7
- Avoid prolonged use on superficial burns as it may delay healing 3
Burn Center Referral Criteria
Refer immediately to a specialized burn center for: 2, 4
- All facial burns regardless of size (high risk of functional and cosmetic disability) 2
- Partial thickness burns >10% total body surface area 4
- Burns to hands, feet, or genitals 3
- Signs of inhalation injury (facial burns, difficulty breathing, singed nasal hairs, soot around nose/mouth) 2, 4
Ongoing Wound Care
- Reapply dressings after hydrotherapy 7
- Monitor for adequate fluid resuscitation in burns >10% body surface area 4
- Continue treatment until satisfactory healing or wound is ready for grafting 7
- Reassess frequently for signs of infection or delayed healing 8
Critical Pitfalls to Avoid
- Failing to recognize that all facial burns require specialized burn center care regardless of size 2
- Using silver sulfadiazine as first-line when superior alternatives exist 5, 6
- Applying ice directly to burns 2, 3
- Rupturing intact blisters 2, 3
- Underestimating airway compromise risk with facial burns 2