What are the diagnosis and management of second-degree (2nd) burns?

From the Guidelines

Second-degree burns should be managed by cooling the burn with room temperature water for 10-15 minutes, cleaning the area gently with mild soap and water, and applying a thin layer of petroleum jelly or an antibiotic ointment, with medical attention necessary for burns larger than 3 inches or those on sensitive areas. The diagnosis of second-degree burns is primarily clinical, based on the burn's appearance and depth, presenting with redness, pain, blistering, and sometimes a weeping appearance 1. For management, it is essential to stop the burning process and reduce pain by cooling the burn with room temperature water for 10-15 minutes. The area should then be cleaned gently with mild soap and water, and a thin layer of petroleum jelly or an antibiotic ointment like bacitracin or silver sulfadiazine should be applied 1. Some key points to consider in the management of second-degree burns include:

• Covering the burn with a non-stick sterile dressing and changing it daily to promote healing and prevent infection 1
• Managing pain with acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) 1
• Monitoring for signs of infection, such as increased pain, redness, swelling, pus, or fever, and seeking medical attention if these signs develop 1
• Considering the need for specialized care, such as intravenous fluid resuscitation, surgery, and other specialized treatments, for burns involving the face, hands, feet, and genitals, and those involving >10% body surface area (5% in children) 1 It is also crucial to remove jewelry before the onset of swelling to prevent constriction and vascular ischemia, and to be aware of the potential for inhalation injury and carbon monoxide poisoning, especially in patients with signs of inhalation injury such as facial burns, difficulty breathing, singed nasal hairs, or soot around the nose or mouth 1.

From the FDA Drug Label

Silver sulfadiazine cream, USP 1% is a topical antimicrobial drug indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second and third degree burns. Prompt institution of appropriate regimens for care of the burned patient is of prime importance and includes the control of shock and pain. The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions.

Diagnosis and Management of 2nd Degree Burns:

• The management of 2nd degree burns involves prompt institution of appropriate regimens for care of the burned patient, including control of shock and pain.
• Cleansing and debridement of the burn wounds are necessary before applying silver sulfadiazine cream, USP 1% under sterile conditions.
• Silver sulfadiazine cream, USP 1% should be applied once to twice daily to a thickness of approximately one sixteenth of an inch.
• Treatment with silver sulfadiazine cream, USP 1% should be continued until satisfactory healing has occurred or until the burn site is ready for grafting 2, 2.

From the Research

Diagnosis of 2nd Degree Burns

• The diagnosis of 2nd degree burns requires consideration of factors such as burn site, patient age, and burn area 3.
• There is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds, which poses challenges to clinical treatment plans 3.

Management of 2nd Degree Burns

• The management of 2nd degree burns involves prehospital first aid, nonsurgical treatment, surgical treatment, and infection treatment 3.
• A consensus on the treatment of second-degree burn wounds has been developed, providing specific recommendations for management 3.
• Hydrocolloid dressings, such as Duoderm, have been shown to be superior to silver sulfadiazine cream in the outpatient management of second-degree burns, with better wound healing, repigmentation, and less pain 4.
• Silver sulfadiazine is an effective antibacterial agent for topical use in burns, with low toxicity and few side effects 5.
• However, comparative studies have shown that new dressings with and without silver may have better results than silver sulfadiazine for wound healing, and burns treated with dressings without silver may be less likely to become infected 6.

Guidelines for Management

• Guidelines for the management of burns have been developed to support accurate evaluation of severity and initiation of appropriate treatment 7.
• These guidelines aim to provide recommendations for the diagnosis and initial treatment of patients with burns, including minor, moderate, and severe cases 7.
• The Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition) provides a standardized clinical treatment plan, with 58 recommendations for management 3.