What is the appropriate management for a second-degree (partial-thickness) burn on the hand?

Management of Second-Degree Burns on the Hand

Apply petrolatum-based antibiotic ointment (such as triple antibiotic ointment containing bacitracin, neomycin, and polymyxin B) as first-line treatment after immediate cooling, and refer all hand burns to a specialized burn center regardless of size. 1, 2

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, 3, 2
• Remove all jewelry from the hand and fingers before swelling occurs to prevent vascular compromise and compartment syndrome 3, 2
• Monitor for hypothermia during cooling, particularly in children with larger burns 3, 2
• Clean the wound with tap water, isotonic saline, or antiseptic solution after cooling 4, 1, 3

Wound Care and Topical Treatment

Blister Management

• Leave intact blisters alone - do not break or pop them as this significantly increases infection risk 2
• If blisters are already ruptured, leave the epidermis in place to act as a biological dressing 3

First-Line Topical Agent

• Apply a thin layer of petrolatum-based antibiotic ointment (triple antibiotic ointment with bacitracin, neomycin sulfate, and polymyxin B) 1, 2
• This promotes faster reepithelialization and reduces scar formation compared to other agents 1
• Alternative options include honey (reduces healing time by 7.8 days versus silver sulfadiazine) or plain petrolatum 1

What NOT to Use

• Avoid silver sulfadiazine as first-line therapy - it delays healing, worsens scarring, and should not be used for prolonged periods on superficial burns 4, 1, 2
• Never apply ice directly to the burn as it causes additional tissue damage 1, 3, 2
• Never apply butter, oil, or home remedies which can exacerbate injury 1, 3, 2

Dressing Application

• Cover with a clean, non-adherent dressing after applying the topical agent 1, 2
• Change dressing daily or as needed 1
• When applying dressings to the hand, prevent tourniquet effect and monitor distal perfusion 4
• Reevaluate dressings daily for signs of infection (increased pain, redness, swelling, or discharge) 4, 3

Pain Management

• Administer over-the-counter analgesics such as acetaminophen or NSAIDs for pain control 1, 2
• For highly painful injuries, deeper analgesia or general anesthesia may be required during wound care 4

Critical Referral Criteria - ALL Hand Burns Require Specialist Evaluation

All partial-thickness burns involving the hands require evaluation at a specialized burn center, regardless of size, due to high risk of functional disability. 1, 2

Additional urgent referral indications include:

• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) 3, 2
• Burns >10% total body surface area in adults (>5% in children) 2
• Circumferential burns of the hand or digits 1
• Blue, purple, or pale extremities indicating vascular compromise 1

Antibiotic Prophylaxis

• Do not routinely administer prophylactic antibiotics - this is not indicated for outpatient burn management and may increase bacterial resistance 4, 5
• Reserve topical antimicrobials only for areas with necrotic tissue or established infection, not for the entire burn surface 3

Common Pitfalls in Hand Burns

The hand's functional complexity makes proper initial management critical. Inadequate cooling, inappropriate topical agents (especially silver sulfadiazine), failure to remove jewelry promptly, and delayed specialist referral are the most common errors that lead to poor functional outcomes and hypertrophic scarring. 1, 2 Even small second-degree burns on the hand warrant specialist evaluation because contractures and loss of fine motor function can develop from seemingly minor injuries.