How should a one‑week‑old superficial chemical burn on the scalp be treated?

Treatment of a One-Week-Old Chemical Burn to the Scalp

For a week-old superficial chemical burn on the scalp, apply petrolatum-based antibiotic ointment and cover with a clean non-adherent dressing, changing it daily, while monitoring closely for signs of infection that would require immediate medical attention. 1

Immediate Assessment at This Stage

Since the burn is already one week old, the critical irrigation window has passed, but you must now assess:

• Burn depth classification: Determine if this is truly superficial (first-degree with intact skin) versus partial-thickness (second-degree with blistering or open areas) 1
• Signs of infection: Look for increased redness, warmth, purulent drainage, fever, or worsening pain—any of these mandate immediate medical referral 1
• Healing progress: Superficial burns should show signs of re-epithelialization by one week; lack of healing suggests deeper injury requiring specialist evaluation 1

Current Wound Care Protocol

For Superficial Burns (Skin Intact):

• Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera to the affected area 2, 1
• Cover with a clean, non-adherent dressing such as Xeroform, Mepitel, or Allevyn 1
• Re-evaluate the dressing daily to monitor healing and detect early infection 1
• Administer over-the-counter pain medications (acetaminophen or NSAIDs) as needed for pain control 2, 1

For Partial-Thickness Burns (If Blistering or Open):

• Clean the wound with tap water, isotonic saline, or antiseptic solution before each dressing change 1
• Apply a thin layer of petrolatum-based antibiotic ointment 1
• Cover with non-adherent dressing and change daily 1
• Note: Silver sulfadiazine should be avoided for prolonged use on superficial burns as it may delay healing 1, 3

Critical Pitfalls to Avoid

• Do not break any intact blisters, as this significantly increases infection risk 1
• Do not apply topical antibiotics routinely—reserve them only for infected wounds, not as prophylaxis 1
• Do not use silver sulfadiazine long-term on superficial burns, as it is associated with prolonged healing 1
• Do not ignore signs of deeper injury: Chemical burns can be deceptively deep and may require weeks to fully declare their depth 4, 5

When to Seek Immediate Medical Attention

You must refer immediately if any of the following are present:

• Signs of infection (increased pain, redness, warmth, purulent drainage, fever) 1
• Lack of healing progress after one week suggests deeper injury 1, 4
• Involvement of face, hands, feet, or genitals—these areas require specialized burn center care regardless of apparent depth 2, 1
• Full-thickness injury (white, leathery, or charred appearance with no sensation) 2, 1
• Burn area >5% body surface area in children or >10% in adults 2, 1

Special Considerations for Scalp Burns

• Scalp burns can involve underlying bone, and full-thickness scalp burns have high morbidity requiring complex reconstruction 6
• Early excision with flap coverage is preferred for deep scalp burns when feasible, as it reduces hospitalization and virtually eliminates sepsis risk compared to conservative management 6
• If bone exposure develops, this requires immediate surgical consultation for debridement and grafting 6

Pain Management

• Multimodal analgesia should be used with medications titrated based on validated pain assessment scales 1, 7
• Over-the-counter NSAIDs or acetaminophen are appropriate for superficial burns 2, 1
• If pain is severe or increasing, this suggests deeper injury or infection and requires immediate medical evaluation 1, 7

Follow-Up Monitoring

• Daily dressing changes with wound inspection are ideal to detect complications early 1
• Chemical burns can progress in depth over days to weeks, so continued monitoring is essential even if initially appearing superficial 4, 8, 5
• If healing is not complete within 2-3 weeks for a superficial burn, specialist referral is warranted 1