Treatment of First-Degree and Second-Degree Burns
Immediately cool all thermal burns with clean running water for 5-20 minutes, then apply petrolatum-based antibiotic ointment and cover with a non-adherent dressing for second-degree burns, while first-degree burns require only cooling and moisturizing emulsions. 1, 2
First-Degree Burns
Immediate Cooling
- Cool the burn immediately with clean running water for 5-20 minutes to reduce inflammation and tissue damage 1, 3
- Water evaporation produces cooling and reduces inflammation 3
Topical Treatment
- After cooling, apply aqueous emulsions with small amounts of well-tolerated lipids (oil-in-water emulsions) 3
- Foam sprays and lotions are ideal because they are easy and painless to apply 3
- The lipids accelerate repair of the damaged skin barrier and reduce drying 3
- Topical corticosteroids are not recommended, as they have not shown superiority over vehicle alone 3
Pain Management
Expected Outcomes
- First-degree burns generally heal without scarring and have low infection risk 1
Second-Degree Burns
Immediate Cooling
- Cool the burn immediately with clean running water for 5-20 minutes—this is the single most important intervention 1, 2, 4
- Adequate first aid (20 minutes of cool running water within 3 hours of injury) reduces burn wound depth by 39%, accelerates healing by 1.9 days, and decreases grafting requirements by 15% 4
- Monitor preadolescent children closely for signs of hypothermia during active cooling, as even short cooling durations can cause hypothermia in young children 1
- If clean running water is unavailable, cooling superficial burns with ice wrapped in cloth may be reasonable, but never apply ice directly to the burn 1, 2
Pain Management
- Administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain control 1, 2
- Remove any jewelry from the affected area before swelling occurs to prevent constriction and vascular compromise 2, 5
Topical Treatment After Cooling
- Apply petrolatum-based antibiotic ointment (such as triple antibiotic ointment containing bacitracin, neomycin sulfate, and polymyxin B) to small partial-thickness burns being managed at home 2, 6
- Alternative acceptable options include petrolatum alone, honey, or aloe vera 1, 2
- Apply a small amount (equal to the surface area of the tip of a finger) 1-3 times daily 6
- Cover with a clean, non-adherent dressing after topical application 1, 2
When to Seek Immediate Specialized Care
The following second-degree burns require treatment at a specialized burn center: 1, 2, 7
- Burns involving the face, hands, feet, or genitalia (regardless of size)
- Burns covering >10% body surface area in adults (>5% in children)
- Signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs)
- Circular burns that may cause compartment syndrome
- Any concern for deep partial-thickness or full-thickness injury
The American Burn Association emphasizes that burns involving the face, hands, feet, and genitals may require surgical intervention to prevent permanent disability, and specialized burn centers provide concentrated expertise that improves survival and functional outcomes 1, 7
Critical Pitfalls to Avoid
What NOT to Do
- Do not apply butter, oil, or other home remedies to burns—these can trap heat and worsen tissue damage 2, 5
- Do not break or pop blisters—this significantly increases infection risk 2, 5
- Do not apply ice directly to burns—this causes further tissue damage 2, 5
- Do not use silver sulfadiazine cream (Silvadene) for prolonged use on superficial burns—it may delay healing 2, 7
- Do not delay specialist referral for burns in sensitive areas (face, hands, feet, genitals)—this leads to permanent functional impairment 7
Special Safety Consideration
- Avoid oil-based emollients on or near the nostrils when oxygen is in use—these products pose a combustion risk in oxygen-enriched environments 2
- Petrolatum-based antibiotic ointments are safe to use on facial burns in patients receiving oxygen therapy 2