Treatment of Second-Degree Burns to Fingers
Second-degree burns to the fingers require immediate cooling with clean running water for 10-20 minutes, followed by application of petrolatum-based antibiotic ointment and a non-adherent dressing, but all finger burns mandate referral to a specialized burn center regardless of size due to the critical functional importance of the hands. 1, 2
Immediate First Aid (Within Minutes of Injury)
Cooling Protocol
- Cool the burned fingers immediately under clean running water for 10-20 minutes to reduce burn depth, minimize pain, and decrease the need for skin grafting 1, 2
- Use water at approximately 15°C (cool tap water temperature), which provides optimal healing outcomes compared to ice or very cold water 3
- Cooling for as little as 10 minutes still provides benefit, but 20 minutes is optimal based on observational data showing improved re-epithelialization and decreased scarring 4
- Never apply ice directly to the burn, as this causes additional tissue ischemia and worse outcomes 1, 2
Critical Actions During Cooling
- Remove all rings, watches, and jewelry from the affected hand immediately before swelling occurs to prevent vascular compromise and potential digit loss 1, 2
- Monitor children closely for hypothermia during prolonged cooling, especially those under 4 years old 1
Post-Cooling Wound Care
Topical Treatment
- After cooling, apply a petrolatum-based antibiotic ointment (such as triple antibiotic ointment containing bacitracin, neomycin sulfate, and polymyxin B) to the burned fingers 2
- Alternative acceptable options include plain petrolatum, honey, or aloe vera if antibiotic ointment is unavailable 1
- Clean the wound with tap water or isotonic saline before applying topical treatment 1
Dressing Application
- Cover with a clean, non-adherent dressing after applying the ointment 1, 2
- Keep the dressing loose to avoid constriction as swelling develops 1
- Change dressings as needed to maintain a moist wound environment, which promotes healing in superficial partial-thickness burns 5
Pain Management
Critical Pitfalls to Avoid
- Do not apply butter, oil, or other home remedies, as these trap heat and worsen tissue injury 1, 2
- Do not break or pop blisters, as intact blisters provide a natural barrier that significantly reduces infection risk 1, 2
- Do not use silver sulfadiazine cream (Silvadene) for prolonged periods on superficial burns, as it may delay healing 2
- Do not apply topical antibiotics as first-line treatment; reserve these for infected wounds only 1
Mandatory Referral Criteria
Immediate Burn Center Referral Required
All second-degree burns involving the fingers require evaluation at a specialized burn center regardless of burn size because:
- Hand burns carry high risk of functional disability and require specialized care to preserve fine motor function 2, 6
- Even small partial-thickness burns on the hands need expert management to optimize functional outcomes 6
- The American Burn Association specifically designates hand burns as requiring specialized burn center treatment 2, 6
Additional Emergency Referral Indications
- Burns covering >10% body surface area in adults (>5% in children) 1, 2
- Any full-thickness (third-degree) burns 1
- Signs of inhalation injury including soot around nose/mouth, difficulty breathing, or singed nasal hairs 1, 2
Special Considerations
Patients with Diabetes
- People with diabetes mellitus are at increased risk of complications and infection from burn injuries 5
- Consider early referral to a burn center for diabetic patients with finger burns 5