What are the treatment options for thermal burns?

From the Guidelines

Treatment for burns should prioritize immediate cooling with cool running water, followed by covering the wound with a nonadherent bandage or clean cloth to protect the wound and reduce pain, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. When managing burns, it's essential to consider the severity of the injury. For minor burns, such as first-degree and small second-degree burns, cooling the burn with cool running water for 10-15 minutes is crucial to stop the burning process and reduce pain. After cooling, applying a thin layer of petroleum jelly or an antibiotic ointment like bacitracin or neosporin can help keep the area moist and prevent infection. Covering the burn with a sterile, non-stick bandage and changing it daily can also aid in the healing process.

For more severe burns, such as large second-degree or any third-degree burns, seeking immediate medical attention is vital. Burns involving the face, hands, feet, and genitals may require surgical intervention to prevent permanent disability, as stated in the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Additionally, burns with a large surface area can lead to significant fluid loss and multisystem organ failure, emphasizing the need for prompt medical attention.

Some key considerations in burn treatment include:

• Removing jewelry before the onset of swelling to prevent constriction and vascular ischemia
• Using over-the-counter analgesics such as acetaminophen or NSAIDs for burn pain management, as they are well-tolerated and generally recommended 1
• Avoiding home remedies like butter, oil, or toothpaste, as they can trap heat and cause infection
• Keeping the burned area elevated if possible to reduce swelling, and ensuring tetanus vaccination is up to date

It's also important to note that specialized burn dressings, such as petrolatum, honey, and aloe, have been shown to improve healing time in patients with partial-thickness burns, but their use in the first aid setting has not been well studied 1. Overall, proper treatment of burns is critical to preventing infection, promoting healing, and minimizing scarring, and should be guided by the most recent and highest-quality evidence available.

From the FDA Drug Label

Prompt institution of appropriate regimens for care of the burned patient is of prime importance and includes the control of shock and pain. The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions. The cream should be applied once to twice daily to a thickness of approximately one sixteenth of an inch. Treatment with silver sulfadiazine cream, USP 1% should be continued until satisfactory healing has occurred or until the burn site is ready for grafting.

The treatment for burns includes:

• Cleansing and debridement of the burn wounds
• Application of silver sulfadiazine cream, USP 1% under sterile conditions
• Covering the burn areas with the cream at all times
• Reapplying the cream once to twice daily to a thickness of approximately one sixteenth of an inch
• Continuing treatment until satisfactory healing has occurred or until the burn site is ready for grafting 2

From the Research

Treatment Options for Burns

• Silver sulfadiazine is an effective agent with low toxicity and few side effects for topical use in burns, as stated in 3.
• However, recent findings indicate that silver sulfadiazine may delay the wound-healing process and have serious cytotoxic activity on various host cells, as mentioned in 4.
• A systematic review found that many new dressings show superior healing properties compared to silver sulfadiazine, but no dressing has a clear benefit over silver sulfadiazine regarding infection, as reported in 5.

Management of Burn Injuries

• Early management of burn injuries is essential to reduce patient mortality and morbidity, and involves accurate assessment of burn depth and appropriate fluid management, as stated in 6.
• Initial treatment of burn injuries is directed at stopping the burn process, and superficial burns can be treated with simple first-aid techniques and over-the-counter pain relievers, as mentioned in 7.
• Partial-thickness and full-thickness burns require more advanced treatment, including advanced dressings and possible referral to a burn center, as reported in 7.

Considerations for Specific Patient Groups

• People with diabetes mellitus are at increased risk of complications and infection from burn injuries, and early referral to a burn center should be considered, as stated in 7.
• Burn injuries are more likely to occur in children and older people, and patient education during primary care visits may be an effective prevention strategy, as mentioned in 7.