What is the severity and medical treatment for a second-degree burn?

From the Guidelines

Second-degree burns require immediate medical attention if they are larger than 3 inches in diameter, involve the face, hands, feet, genitals, or major joints, or show signs of infection, as these burns can lead to significant morbidity, mortality, and impact quality of life. For treatment of second-degree burns, begin by cooling the burn with cool (not cold) running water for about 10-15 minutes to stop the burning process, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Clean the area gently with mild soap and water, then apply an antibiotic ointment such as bacitracin or silver sulfadiazine to prevent infection, although it's essential to note that silver sulfadiazine may be associated with prolonged healing if used for a long time on superficial burns 1. Cover the burn with a non-stick sterile dressing like Telfa or petroleum-impregnated gauze, and secure it with gauze wrap or medical tape, ensuring that the dressing does not induce a tourniquet effect 1. Change dressings daily or as directed by a healthcare provider. For pain management, take acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) as needed, as these are well-tolerated and generally recommended for burn pain 1. Superficial second-degree burns typically heal within 2-3 weeks, while deep partial-thickness burns may take longer and have a higher risk of scarring.

Some key considerations in the management of second-degree burns include:

• The role of antibiotic prophylaxis, which may be beneficial in high-risk patients but is not recommended as a universal prophylaxis 1
• The importance of wound care, including cleaning and dressing the wound, to prevent infection and promote healing 1
• The need for surgical intervention in some cases, such as burns involving the face, hands, feet, and genitals, or those with a large surface area 1
• The potential for burn wound infections, which can be polymicrobial and require comprehensive management, including surgical debridement and antibiotic therapy 1

It's crucial to prioritize the management of second-degree burns to minimize the risk of complications and promote optimal healing, as these burns can have a significant impact on morbidity, mortality, and quality of life.

From the FDA Drug Label

Silver sulfadiazine cream, USP 1% is a topical antimicrobial drug indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second and third degree burns. Mafenide Acetate should be used with caution in burn patients with acute renal failure. Close monitoring of acid-base balance is necessary, particularly in patients with extensive second-degree or partial-thickness burns and in those with pulmonary or renal dysfunction

The medical treatment for second-degree burn severity includes the use of topical antimicrobial drugs such as silver sulfadiazine and mafenide acetate.

• Silver sulfadiazine is used as an adjunct for the prevention and treatment of wound sepsis in patients with second and third degree burns.
• Mafenide acetate should be used with caution in burn patients, particularly those with extensive second-degree or partial-thickness burns, and requires close monitoring of acid-base balance 2 3.

From the Research

Second-Degree Burn Severity

• Second-degree burns are the most common type of burn in clinical practice and can be challenging to manage 4, 5.
• The severity of second-degree burns can vary, with superficial partial-thickness burns extending into the dermis and taking up to three weeks to heal, while deep partial-thickness burns may require immediate referral to a burn surgeon for possible early tangential excision 6.

Medical Treatment

• The treatment of second-degree burns requires consideration of factors such as the burn site, patient age, and burn area 4.
• Prehospital first aid and non-surgical treatment are crucial in the management of second-degree burns, with recommendations including the use of advanced dressings to protect the wound and promote a moist environment 5.
• Topical chemotherapeutic agents, such as mafenide acetate solution dressings, can be used as an adjunct in burn wound care to control bacterial growth and promote healing 7.
• Silver sulfadiazine therapy has been shown to be effective in managing second- and third-degree burns, with benefits including enhanced healing, granulation tissue formation, and infection control 8.

Treatment Considerations

• Patient education during primary care visits may be an effective prevention strategy for burn injuries, particularly in high-risk populations such as children and older adults 6.
• People with diabetes mellitus are at increased risk of complications and infection, and early referral to a burn center should be considered 6.
• Prophylactic antibiotics are not indicated for outpatient management of burn injuries and may increase bacterial resistance 6.