What is the treatment for swelling and burning?

Treatment for Swelling and Burning

For acute swelling and burning from thermal burns, immediately cool the affected area with clean running water for 5-20 minutes, then apply petrolatum-based antibiotic ointment and cover with a clean, non-adherent dressing. 1, 2, 3

Immediate First-Line Management (First 20 Minutes)

Cooling Phase

• Apply clean running water for 5-20 minutes to limit tissue damage and reduce both pain and swelling 4, 1, 2
• Use water temperature between 15-25°C (room temperature or cool tap water) 4
• Never apply ice directly to the affected area, as this causes additional tissue damage and can worsen outcomes 4, 1, 2
• Monitor for hypothermia in children during prolonged cooling, especially with larger affected areas 1, 2

Concurrent Actions During Cooling

• Remove any jewelry from the affected area before swelling progresses to prevent vascular compromise 1, 2
• Administer over-the-counter analgesics (acetaminophen or NSAIDs) for pain control 4, 1, 3

Topical Treatment After Cooling

First-Line Topical Agent

• Apply petrolatum-based antibiotic ointment (such as triple antibiotic ointment containing bacitracin, neomycin sulfate, and polymyxin B) as the preferred first-line treatment 1, 3
• This promotes faster reepithelialization and reduces scar formation compared to alternatives 3
• Apply a thin layer to the entire affected area 3

Alternative Topical Options

• Honey may be used and shows benefit for infection resolution with reduced healing time (7.8 days faster than silver sulfadiazine) 3
• Aloe vera is reasonable for small burns managed at home 3
• Plain petrolatum without antibiotics is acceptable if antibiotic ointment is unavailable 1, 3

Dressing Application

• Cover with a clean, non-adherent dressing after applying topical treatment 1, 2, 3
• Change dressing daily or as needed 3

Critical Pitfalls to Avoid

• Do NOT use silver sulfadiazine (Silvadene) as first-line therapy—it delays healing and worsens scarring compared to petrolatum-based treatments 1, 3
• Do NOT apply butter, oil, or home remedies to burns, as these can exacerbate injury 1, 2, 3
• Do NOT break intact blisters, as this significantly increases infection risk 1, 3
• Do NOT use ice directly on burns 4, 1, 2

When to Seek Immediate Medical Attention

High-Risk Anatomic Locations

• Burns involving face, hands, feet, or genitals require specialized burn center evaluation regardless of size, due to high risk of functional disability and cosmetic deformity 1, 2, 3

Severity Indicators

• Burns covering >10% body surface area in adults (>5% in children) 1
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) 1, 2, 3
• Circumferential burns or blue/purple/pale extremities indicating vascular compromise 3
• Signs of infection: increasing pain, redness, swelling, or purulent discharge 2

Special Considerations

For Erythromelalgia (Chronic Burning/Swelling)

If symptoms represent erythromelalgia rather than acute thermal injury, the approach differs significantly:

• Avoid prolonged ice or cold water immersion (limit to 10 minutes, 4 times daily maximum) to prevent tissue damage, ulceration, and "immersion foot" 4
• Elevate extremities during symptom flares 4
• Consider topical treatments as first-line therapy before systemic medications 4
• Aspirin is first-line systemic therapy, particularly for secondary erythromelalgia from myeloproliferative disease 4

Infection Prevention in Burns

• Burn wounds are sterile immediately post-injury but rapidly colonize with bacteria 4, 5, 6
• Gram-positive bacteria colonize first from skin flora, followed by Gram-negative bacteria within one week 4, 5
• Early excision of necrotic tissue substantially decreases invasive infection risk 4, 6