What topical cream is recommended for a patient with a burn to the hand?

Topical Cream for Hand Burns

For a hand burn, apply petrolatum or petrolatum-based antibiotic ointment (such as bacitracin) after cooling the burn with clean running water for 5-20 minutes, then cover with a clean non-adherent dressing. 1, 2

Immediate First Aid (Before Applying Any Cream)

• Cool the burn immediately with clean running water (15-25°C) for 5-20 minutes to limit burn depth progression and reduce pain 1, 2, 3
• Remove jewelry from the hand before swelling occurs to prevent vascular compromise 1
• Clean the wound with tap water, isotonic saline, or antiseptic solution in a clean environment 1, 2

Recommended Topical Agents for Hand Burns

For superficial to partial-thickness burns managed at home:

• Petrolatum (white soft paraffin) is the first-line option—simple, effective, and prevents dressing adherence 1, 2
• Petrolatum-based antibiotic ointment (e.g., bacitracin ointment) can be used as an alternative 1, 2
• Medical-grade honey or aloe vera are acceptable alternatives with antimicrobial properties 1, 2, 3

For deeper partial-thickness burns requiring medical management:

• Silver sulfadiazine cream 1% is FDA-approved for second and third-degree burns and should be applied to a thickness of approximately 1/16 inch once to twice daily 4, 5
• However, avoid prolonged use on superficial burns as it may delay healing 3

Application Technique

• Apply the chosen topical agent in a thin layer covering the entire burn surface 1, 4
• Cover with a clean non-adherent dressing to protect from contamination and reduce pain 1, 2
• When dressing the hand, ensure bandages do not create a tourniquet effect around fingers or wrist 1, 3
• Monitor distal perfusion (check fingertip color, warmth, and capillary refill) 1
• Re-evaluate dressings daily if possible 1

Critical Pitfalls to Avoid

• Do NOT use topical antibiotics as first-line prophylaxis—reserve them only for infected wounds to prevent antimicrobial resistance 1, 2, 3
• Do NOT apply ice directly to the burn as this causes tissue damage and ischemia 2, 3
• Avoid products containing neomycin or bacitracin-impregnated adhesive bandages if there is any history of contact dermatitis, as these are common allergens 6

When to Seek Immediate Medical Attention

Burns to the hand require specialist evaluation in these situations:

• All hand burns should be evaluated by a burn specialist as hands are a critical functional area requiring specialized care 1, 2, 3
• Burns covering >10% total body surface area in adults or >5% in children 1, 2
• All full-thickness (third-degree) burns 1, 2
• Circumferential burns around the hand or fingers that may compromise circulation 3
• Signs of infection (increasing pain, redness, swelling, purulent discharge) 3

Pain Management

• Over-the-counter acetaminophen or NSAIDs for mild to moderate pain 1
• The cooling itself and appropriate moist dressings help reduce pain 3
• Severe burns require prescription opioids or ketamine under medical supervision 2, 3