What is the recommended dressing procedure for 2nd degree burn blisters?

Management of Second-Degree Burn Blisters

Leave burn blisters intact and cover them loosely with a sterile or clean nonadherent dressing—this approach improves healing and reduces pain. 1, 2

Immediate First Aid: Cool First, Then Dress

Before addressing the blister itself, you must cool the burn immediately:

• Cool with clean running tap water (15-25°C) for 5-20 minutes or at minimum until pain is relieved, ideally within 30 minutes of injury 1, 2, 3
• Monitor preadolescent children closely for hypothermia during active cooling with running water 1, 2
• Never apply ice directly to the burn—this causes tissue ischemia and worsens tissue damage 1, 2, 3
• Remove jewelry immediately before swelling occurs to prevent vascular compromise 1, 2, 3

Why Keep Blisters Intact

The evidence strongly supports leaving blisters undisturbed:

• The intact blister serves as a natural biological dressing that provides a sterile barrier protecting the underlying wound from infection and contamination 2, 3
• Keeping blisters intact significantly decreases pain compared to debriding or unroofing them 2
• Multiple studies demonstrate better healing outcomes when blisters remain intact 2

Dressing Protocol After Cooling

For Intact Blisters (Skin Unbroken):

• Cover loosely with a clean cloth or nonadherent dry dressing while awaiting professional evaluation 1, 2
• The dressing should be loose enough to avoid pressure on the blister but protective enough to prevent rupture 1

For Small Partial-Thickness Burns Being Managed at Home:

After cooling, if the blister has opened or for other partial-thickness burns:

• Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera with a clean nonadherent dressing 1, 2, 3
• These topical agents have been shown to improve healing time compared to no dressing or various controls 1
• Change dressing daily or as needed 3

Pain Management

• Administer over-the-counter analgesics such as acetaminophen or NSAIDs for burn pain 1, 2, 3
• These medications are well-tolerated and generally recommended for burn pain management 1

When to Seek Immediate Medical Evaluation

Activate EMS or seek specialized burn center care immediately for: 1, 2, 3

• Burns involving the face, hands, feet, genitals, or perineum—these require surgical intervention to prevent permanent disability
• Burns covering >10% body surface area in adults (>5% in children)—these require IV fluid resuscitation and specialized treatment
• Signs of inhalation injury: facial burns, difficulty breathing, singed nasal hairs, or soot around nose/mouth—this can rapidly lead to airway loss

Critical Pitfalls to Avoid

• Do not puncture, unroof, or debride blisters in the first aid setting 1, 2, 3
• Do not apply ice, ice water, butter, oil, or other home remedies to burns 1, 2, 3
• Do not delay cooling—it must be initiated as soon as possible, ideally within 30 minutes of injury 2, 3
• Do not cool large burns without monitoring core temperature, especially in children, due to hypothermia risk 1, 2, 3
• Do not use prolonged silver sulfadiazine on superficial burns—it is associated with prolonged healing compared to other dressings 3, 4

Nuances in the Evidence

While the American Heart Association and American Red Cross guidelines consistently recommend leaving blisters intact (Class IIa, Level of Evidence B) 1, 2, some burn specialists advocate for sterile aspiration and drainage in certain clinical contexts 5. However, for first aid and initial management, the consensus is clear: leave blisters intact 1, 2. The intact blister provides superior protection and pain control compared to any intervention that disrupts it 2.