What is the recommended management for a first-degree (superficial) burn?

Management of First-Degree Burns

First-degree burns should be immediately cooled with clean running water, then treated with simple over-the-counter pain relievers and aqueous emulsions or petrolatum-based products, as these superficial injuries heal without scarring and carry minimal infection risk. 1

Immediate Cooling

• Cool the burn immediately with clean running water for 5 to 20 minutes to reduce pain, limit tissue damage, and decrease the need for subsequent medical care 1
• If clean running water is unavailable, cooling with ice wrapped in cloth may be reasonable for superficial burns with intact skin, but never apply ice directly to the burn as this can cause tissue ischemia 1
• Monitor preadolescent children during active cooling for signs of hypothermia, particularly with larger surface area burns 1

Pain Management

• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain control after cooling 1
• Pain relief is typically adequate with these simple analgesics since first-degree burns involve only the epidermis 2

Topical Treatment

• After cooling, apply aqueous emulsions with small amounts of well-tolerated lipids (oil-in-water emulsions), petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 3
• Water in these emulsions evaporates to produce cooling and reduce inflammation, while lipids accelerate repair of the damaged skin barrier 3
• Foam sprays and lotions are ideal because they are easy and painless to apply 3
• Topical corticosteroids are not recommended as they have not shown superiority over vehicle alone 3

Wound Coverage

• Loosely cover the burn with a clean cloth or nonadherent dry dressing if the skin or blister remains intact 1
• For small burns being managed at home, apply the topical agent and cover with a clean nonadherent dressing 1

Expected Course and Prognosis

• First-degree burns involve only the epidermal layer and heal without scarring 1, 2
• The risk of infection is low with these superficial injuries 1
• These burns require only simple first-aid techniques and do not necessitate advanced wound care 2

Critical Pitfalls to Avoid

• Do not apply butter, oil, or other home remedies to burns, as these can worsen tissue damage 4
• Do not apply ice directly to the burn, as this produces tissue ischemia and can cause further local tissue injury 1
• Do not use prolonged cold exposure, especially for larger burns, as this can cause hypothermia 1
• Prophylactic systemic antibiotics are not indicated for first-degree burns 2

When Medical Attention Is Not Required

• First-degree burns can be managed entirely with home first aid measures 2
• These burns do not require referral to a burn center or specialist evaluation 1
• No advanced dressings or specialized wound care products are necessary 2