Does povidone-iodine (Betadine) aid in the treatment of thermal burns?

From the Guidelines

Betadine (povidone-iodine) is not recommended for treating burns. The most recent and highest quality study, published in 2024 in the journal Circulation, found that several studies have not demonstrated a benefit of wound cleansing with povidone-iodine in addition to irrigation 1. This suggests that the use of Betadine may not provide any additional benefits in preventing infection, and may even be harmful to burned tissue.

For minor burns, the best approach is to cool the burn with cool running water for about 10-20 minutes, then cover it with a clean, non-stick bandage or sterile gauze. Some key considerations for burn care include:

• Cooling the burn with cool running water to reduce temperature and ease pain
• Covering the burn with a clean, non-stick bandage or sterile gauze to protect the wound
• Avoiding the use of harsh antiseptics, such as Betadine, which can damage already injured skin cells and delay healing
• Seeking immediate medical attention for more severe burns, without applying any home remedies

Additionally, the 2020 study published in the journal Anaesthesia found that burn wound care should be performed in a clean environment and will mostly require deep analgesia or general anaesthesia, and that the type of dressing depends on the total body surface area (TBSA) affected, the local appearance of the wound, and the patient’s general condition 1. However, the most recent and highest quality study 1 takes precedence in guiding our recommendation. The use of Betadine is not supported by the most recent evidence, and gentle care that promotes healing is the best approach for treating burns.

From the Research

Effectiveness of Betadine on Burns

• There is no direct mention of Betadine in the provided studies, but we can look at the effectiveness of antiseptics and topical antimicrobial agents on burns.
• A study published in 2017 2 found that antiseptics such as silver-based, honey, and iodine-based treatments may be effective in promoting healing and preventing infection in burn wounds.
• Another study published in 2022 3 found that silver-containing dressings are often recommended over antiseptics or antibiotics for preventing infection in burn wounds.
• A study published in 2021 4 discussed the history and current status of topical antimicrobial agents for burn wound care, highlighting the importance of effective topical antimicrobial agents in preventing infection and promoting healing.

Comparison of Topical Antimicrobial Agents

• The 2017 study 2 compared various antiseptic agents, including silver-based, honey, and iodine-based treatments, and found that some may be more effective than others in promoting healing and preventing infection.
• The 2020 study 5 tested the in vitro effectiveness of various topical antimicrobials, including compounded preparations, and found that some were effective against a broad spectrum of microorganisms.
• The 2022 study 3 found that there is no ideal topical antimicrobial agent that can be recommended for all clinical scenarios, and that more consistent recommendations are needed to standardize clinical practice.

Limitations and Future Research

• Many of the studies had limitations, including poorly reported methodology and low certainty evidence, which makes it difficult to draw firm conclusions about the effectiveness of antiseptics and topical antimicrobial agents on burns.
• Further research is needed to develop more consistent recommendations and to address the gaps in our ability to treat complicated burn wounds, including fungal infections and wounds in patients with impaired healing or advanced age or medical comorbidities 4.