What is the recommended treatment for a patient with a hand burn?

Hand Burn Treatment Prescription

For hand burns, immediately cool with running water for 5-20 minutes, then apply a petrolatum-based antibiotic ointment (such as bacitracin or Polysporin) covered with a non-adherent dressing, and refer to a burn specialist regardless of burn size due to the critical functional importance of the hand. 1

Immediate Initial Management

• Cool the burn immediately with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2
• Remove all jewelry from the hand and fingers before swelling occurs to prevent vascular compromise from constriction 1, 2
• Administer pain control with acetaminophen or NSAIDs as first-line agents for minor burns 1
• Do not apply ice directly to the burn as this causes further tissue damage 1, 3
• Avoid home remedies such as butter or oil which can worsen outcomes 1, 3

Wound Cleaning and Assessment

• Cleanse the wound with tap water, isotonic saline solution, or an antiseptic solution before applying any dressing 4, 1
• Assess burn depth to determine appropriate treatment:
  • First-degree burns: erythema only, no blisters
  • Superficial second-degree: blisters present, painful
  • Deep second-degree or full-thickness: requires specialist evaluation 1

Blister Management (if present)

• Preserve intact blisters when possible, as the blister roof acts as a biological dressing that reduces pain and promotes healing 1, 2
• If decompression is needed, pierce at the base with a sterile needle and express fluid while keeping the roof intact 1, 2
• Never completely break or pop blisters as this significantly increases infection risk 1

Topical Treatment Selection

For Superficial Burns (First-Degree and Superficial Second-Degree):

• Apply petrolatum-based antibiotic ointment such as bacitracin, Polysporin (polymyxin B + bacitracin), or triple-antibiotic ointment 1, 3
• Alternative option: Apply 50% white soft paraffin with 50% liquid paraffin as a greasy emollient 1
• Avoid silver sulfadiazine for prolonged use on superficial burns as it is associated with delayed healing 1, 2

For Deeper or Contaminated Burns:

• Silver sulfadiazine 1% cream may be used for partial-thickness burns but should not be used long-term on superficial burns 5, 6
• Apply once to twice daily to a thickness of approximately 1/16 inch 5
• Topical antimicrobials should be applied only to sloughy or contaminated areas, not routinely to all burn surfaces 1

Dressing Application

• Cover with non-adherent dressing such as Mepitel (silicone-coated), Telfa, or Xeroform (petrolatum-impregnated gauze) 1, 3
• Secure the dressing to protect the wound while avoiding circumferential wrapping that could create a tourniquet effect 4
• Monitor distal perfusion if any circumferential dressing is necessary 4

Antibiotic Considerations

• Do not prescribe prophylactic systemic antibiotics routinely for burn wounds 4, 1
• Topical antibiotics should not be first-line treatment but reserved for infected wounds only 4
• Exception: Consider antibiotics for bite wounds to the hand (different clinical scenario) 4

Follow-Up Care

• Re-evaluate dressings daily to monitor for signs of infection or wound progression 4, 1
• Change dressings as needed in a clean environment, maintaining sterile technique 4
• Monitor for infection signs: increased pain, redness, swelling, purulent discharge, or fever 1

Mandatory Specialist Referral

All hand burns require specialized burn care regardless of size because:

• The hand is a critical functional area requiring specialized management 1, 6
• Burns to hands, face, feet, and genitalia need specialist evaluation even if small 1, 2
• Early specialist involvement optimizes functional outcomes and minimizes long-term disability 1

Common Pitfalls to Avoid

• Do not delay specialist referral for hand burns even if they appear minor initially 1
• Avoid prolonged cooling or external cooling devices during transport as this risks hypothermia 4
• Do not use silver sulfadiazine routinely on superficial hand burns due to delayed healing 1, 2
• Never apply circumferential dressings without monitoring distal perfusion 4
• Do not prescribe prophylactic oral antibiotics unless specific high-risk features are present 4, 1

Pain Management Algorithm

• Mild pain: Acetaminophen or NSAIDs 1
• Moderate pain: Consider short-term opioids if acetaminophen/NSAIDs insufficient 6
• Severe pain or dressing changes: May require procedural sedation or general anesthesia 4