What is the treatment for a patient with a partial thickness surface burn?

Treatment of Partial Thickness Surface Burns

Apply petrolatum or petrolatum-based antibiotic ointment as first-line treatment after immediate cooling with clean running water for 5-20 minutes, then cover with a clean, non-adherent dressing changed daily. 1

Immediate First Aid Management

• Cool the burn immediately with clean running water at approximately 15°C for 20 minutes to limit tissue damage and reduce pain 2, 1, 3

  • Cooling for as little as 10 minutes still provides benefit, and delays up to 1 hour in applying first aid still show improved outcomes 4
  • Water at 2°C is also beneficial, but avoid ice application as it causes additional tissue damage 2, 1, 3
  • Monitor preadolescent children for hypothermia during cooling 5

• Remove jewelry from the affected area before swelling occurs to prevent vascular compromise 2, 5

• Administer over-the-counter analgesics (acetaminophen or NSAIDs) for pain control 2, 1, 5

Topical Treatment Protocol

Petrolatum-based antibiotic ointment is the preferred first-line treatment because it promotes faster reepithelialization and reduces scar formation compared to silver sulfadiazine 1

• Apply a thin layer of petrolatum-based antibiotic ointment (such as triple antibiotic ointment containing bacitracin, neomycin sulfate, and polymyxin B) to the cleaned wound 1, 5

• Alternative agents with evidence of benefit:

  • Honey shows decreased mean healing time of 7.8 days compared to silver sulfadiazine, with benefits for infection resolution and reduced hypertrophic scarring 1
  • Aloe vera may be reasonable for small burns managed at home 1
  • Hydrogel dressings appear to heal more quickly than usual care 6

Dressing Application

• Cover with a clean, non-adherent dressing after applying topical agent 1, 5
• Change dressing daily or as needed 1
• Silver-containing foam dressings offer the advantage of less frequent dressing changes with similar healing outcomes to traditional dressings, plus reduced pain during early treatment 7

Critical Pitfalls to Avoid

• Do not use silver sulfadiazine as first-line therapy - it delays healing and worsens scarring compared to petrolatum-based treatments 1, 6
• Do not apply ice directly to burns 2, 1, 5
• Do not apply butter, oil, or home remedies 2, 1, 5
• Do not break intact blisters as this significantly increases infection risk 2, 1, 5
• Avoid oil-based emollients near oxygen delivery sites in patients on oxygen therapy due to combustion risk 5

When to Seek Specialized Burn Center Care

All partial-thickness burns involving the face, hands, feet, or genitals require evaluation at a specialized burn center regardless of size due to high risk of functional disability and cosmetic deformity 2, 1, 5

Additional criteria requiring specialized care:

• Burns >10% total body surface area in adults (>5% in children) 1, 5
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs) 2, 1, 5
• Circumferential burns 1
• Blue, purple, or pale extremities indicating vascular compromise 1