What is the recommended treatment for a patient with a second-degree burn?

Treatment of Second-Degree Burns

Immediately cool the burn with clean running water for 5-20 minutes, then apply a petrolatum-based triple antibiotic ointment (bacitracin, neomycin, polymyxin B) covered with a non-adherent dressing. 1, 2

Initial Management

Immediate Cooling

• Cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2
• The 2021 ILCOR guidelines recommend immediate active cooling but note that no specific duration can be definitively recommended based on available evidence, as studies comparing different durations showed no significant differences in outcomes 3
• Monitor young children (<4 years) for hypothermia during cooling, particularly if whole-body cooling is used 3, 1
• Never apply ice directly to burns as this causes further tissue damage 1, 2

Pre-Treatment Steps

• Remove all jewelry from the affected area before swelling occurs to prevent vascular compromise 1, 2
• Clean the wound with tap water, isotonic saline, or antiseptic solution before applying any dressing 2
• Administer acetaminophen or NSAIDs for pain management 1

Topical Treatment

Preferred Agent

• Apply petrolatum-based triple antibiotic ointment (containing bacitracin, neomycin sulfate, and polymyxin B) after cooling 1, 2
• This approach is supported by preclinical evidence showing superior reepithelialization and reduced scarring compared to silver-based dressings 4
• Cover with a clean, non-adherent dressing after ointment application 1, 2

Alternative Dressing Options

• Paraffin gauze can be applied directly to the burn wound as a primary non-adherent dressing 2
• Paraffin gauze may be combined with greasy emollients (50% white soft paraffin with 50% liquid paraffin) 2

What to Avoid

• Avoid prolonged use of silver sulfadiazine (Silvadene) on superficial burns as it may delay healing 1, 2
• Never apply butter, oil, or other home remedies 1, 2

Blister Management

• Do not break or pop blisters as this significantly increases infection risk 1, 5
• A burn specialist should ideally determine whether blisters require intervention 5

Dressing Changes and Monitoring

• Change dressings every 1-2 days based on wound condition 2
• Reassess the wound at each dressing change for healing progress and signs of infection 2
• Monitor for increased pain, redness extending beyond burn margins, swelling, or purulent discharge as signs of infection 2
• Reserve systemic antibiotics for clinically evident infections only, not for prophylaxis 2

When to Seek Specialized Care

High-Risk Anatomic Locations

• Burns involving the face, hands, feet, or genitalia require specialized care regardless of size 1, 5
• These areas carry higher risk of functional impairment and require expert management 5

Burn Size Thresholds

• Burns covering >10% body surface area in adults (>5% in children) should be treated in a specialized burn center 1, 2

Inhalation Injury

• Seek immediate medical attention for signs of inhalation injury including soot around nose/mouth or difficulty breathing 1

Special Safety Considerations

Oxygen Therapy

• Avoid oil-based emollients near the nostrils when oxygen is in use due to combustion risk in oxygen-enriched environments 1
• Petrolatum-based antibiotic ointments are safe to use on facial burns in patients receiving oxygen therapy 1
• Ensure hands are dried after using alcohol-based hand sanitizers before applying topical agents to minimize combustion risk 1

Common Pitfalls

• Do not delay seeking medical attention for burns in sensitive areas or covering large surface areas 1
• Do not use ice for cooling 1, 2
• Do not break blisters 1, 5
• Do not apply home remedies like butter or oil 1, 2
• Do not use silver sulfadiazine for prolonged periods on superficial burns 1, 2