What to do when a burn blister ruptures and exposes a raw area?

Management of Ruptured Burn Blisters with Exposed Raw Areas

When a burn blister ruptures spontaneously, leave the overlying skin in place as a biological dressing, gently clean the area with warmed sterile water or saline, apply a greasy emollient like 50% white soft paraffin with 50% liquid paraffin, and cover with a non-adherent dressing. 1, 2

Immediate Wound Care Steps

Step 1: Leave the Blister Roof Intact

• Do not remove the detached skin – the overlying epidermis acts as a natural biological dressing that protects the wound, reduces pain, and decreases infection risk 1, 2
• If the blister has already completely separated, proceed directly to cleaning 2

Step 2: Gentle Wound Cleansing

• Irrigate the area gently using warmed sterile water, normal saline, or dilute chlorhexidine (1:5000) 1, 2, 3
• Use gentle irrigation only – avoid high-pressure irrigation as this can drive bacteria deeper into tissues 1
• Remove any loose debris or foreign matter during this process 2, 3
• Ensure adequate pain control before wound care; consider over-the-counter analgesics like acetaminophen or ibuprofen 1, 2

Step 3: Apply Greasy Emollient

• Apply a thick layer of greasy emollient such as 50% white soft paraffin with 50% liquid paraffin over the entire exposed area 1, 2
• Alternative options include petrolatum, petrolatum-based antibiotic ointment, medical-grade honey, or aloe vera 1, 2, 3
• This significantly reduces complications including hypertrophic scarring compared to dry dressings 2, 3
• Consider using aerosolized formulations to minimize shearing forces if available 1

Step 4: Apply Non-Adherent Dressing

• Cover the emollient-coated wound with a non-adherent dressing such as Mepitel™ or Telfa™ 1, 2
• Apply a secondary foam or burn dressing (such as Exu-Dry™) over the non-adherent layer to collect exudate 1, 2
• Ensure the dressing is not too tight to avoid tourniquet effect on limbs 4

Infection Prevention and Monitoring

When to Use Topical Antimicrobials

• Do not apply topical antibiotics routinely – reserve antimicrobial agents only for sloughy or obviously infected areas 1, 2, 3
• Indiscriminate antibiotic use promotes antimicrobial resistance and may delay healing 1, 2, 3
• If infection develops (increasing pain, redness, purulent discharge), apply topical antimicrobial guided by local microbiological advice 1, 3
• Consider silver-containing products for infected areas, but limit use if extensive areas are being treated due to absorption risk 1

Signs Requiring Medical Evaluation

• Increasing pain, redness, swelling, or purulent discharge indicating infection 3
• Fever, confusion, or systemic signs of sepsis 1
• Delayed healing or wound conversion (progression to deeper injury) 1
• Any burn involving face, hands, feet, genitals, or >10% body surface area in adults (>5% in children) 1, 2, 3

Pain Management

• Over-the-counter analgesics (acetaminophen or NSAIDs) are generally well-tolerated and recommended for burn pain 1, 2
• The combination of covering the wound and applying emollient provides non-pharmacological pain relief 2, 4
• For severe pain, short-acting opioids may be necessary 2, 3

Critical Pitfalls to Avoid

• Never completely unroof or remove the blister skin – this significantly increases infection risk and removes the natural biological barrier 2, 5
• Never apply ice directly – this causes additional tissue ischemia and damage 1, 2, 3, 4
• Never apply butter, oil, or home remedies – these increase infection risk and delay healing 2, 3
• Never use topical antibiotics on uninfected wounds – this promotes antimicrobial resistance without benefit 1, 2, 3
• Never delay specialist referral for burns involving high-risk anatomic locations (hands, face, feet, genitals) or large surface areas 1, 2, 3

Follow-Up Care

• Change dressings daily or as needed based on exudate levels 2
• Monitor for signs of infection at each dressing change 3
• Re-epithelialization typically occurs within days to weeks depending on burn depth 1
• If healing is delayed beyond 2-3 weeks or signs of infection develop, seek medical evaluation 1, 3