Management of Second-Degree Burns on the Hand
All second-degree burns involving the hands require evaluation at a specialized burn center regardless of size, due to the high risk of functional disability. 1, 2, 3
Immediate Initial Management (First 20 Minutes)
- 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 before swelling occurs to prevent vascular compromise and constriction injury 1, 2
- Administer acetaminophen or NSAIDs for pain control 1, 2
- Monitor for hypothermia during cooling if the patient is a preadolescent child 1
Wound Care and Topical Treatment
After cooling, the algorithmic approach is:
- Apply petrolatum-based antibiotic ointment (such as triple antibiotic ointment containing bacitracin, neomycin sulfate, and polymyxin B) as first-line treatment 1, 2
- Cover with a clean, non-adherent dressing after ointment application 1, 2
- Change dressing daily or as needed 2
Why This Specific Agent?
The American Heart Association specifically recommends petrolatum-based antibiotic ointment over other agents because it promotes faster reepithelialization and reduces scar formation 2. Research supports that hydrocolloid dressings achieve fastest epithelialization (15.7 days) with better functional outcomes in hand burns 4, though guidelines prioritize petrolatum-based ointments for initial outpatient management.
Critical Agents to AVOID
- Do NOT use silver sulfadiazine (Silvadene) as first-line therapy - it delays healing and worsens scarring compared to petrolatum-based treatments 2
- This recommendation directly contradicts older practice patterns where silver sulfadiazine was considered standard 5, 6, but current American Heart Association guidelines explicitly advise against it for superficial burns 1, 2
Mandatory Referral Criteria
Refer immediately to a specialized burn center because: 2, 3
- Hand burns carry high risk of functional disability regardless of size 2, 3
- Specialized care optimizes functional outcomes and minimizes contracture formation 2, 3
- Burns covering >10% body surface area in adults (>5% in children) require burn center treatment 1
- Circumferential burns or signs of vascular compromise (blue, purple, or pale extremities) need immediate specialized evaluation 2
Common Pitfalls to Avoid
- Do NOT apply ice directly - causes additional tissue damage 1, 2
- Do NOT apply butter, oil, or home remedies - exacerbates injury 1, 2
- Do NOT break intact blisters - significantly increases infection risk 1, 2
- Do NOT delay referral to burn center thinking you can manage hand burns outpatient - functional outcomes depend on specialized early intervention 2, 3
- Do NOT use prophylactic systemic antibiotics - not indicated for most burn patients 5