Treating a 2-Day-Old Burn

Step 1 - Clean the wound first

Step 2 - What to Apply (by burn type)

For superficial / minor partial-thickness burns (most common at home):

1. Bacitracin or Polysporin ointment - This is the first-line recommendation for most outpatient minor burns. Use plain bacitracin (not Neosporin/neomycin-containing products, as they can cause contact dermatitis). Apply a thin layer and cover with a non-adherent gauze dressing.
2. Petroleum jelly (Vaseline) - A good alternative for wounds with low contamination risk. Keeps the wound moist, reduces pain, and does not stick to overlying dressings. Apply and cover with gauze.
3. Silver sulfadiazine (Silvadene) cream 1% - A broad-spectrum antibacterial/antifungal cream, classically the "standard" burn treatment. Still appropriate for contaminated or infected burns, or if the wound has signs of early infection. Apply a thin layer once daily. Note: it forms a white pseudomembrane over partial-thickness burns that can be painful to remove; it is no longer the first-line recommendation for minor clean burns per current guidelines.
4. Aloe vera cream (50%+ concentration) - A reasonable, inexpensive option with demonstrated activity against common burn pathogens (Pseudomonas, Staph aureus, Klebsiella). Healing times are comparable to silver sulfadiazine for minor burns. Acceptable for open or dressed outpatient care.
5. Honey - Medical-grade honey (or pure natural honey) has antibacterial and anti-inflammatory properties due to its osmotic effect and acidic pH. Evidence suggests it may actually be superior to silver sulfadiazine for minor burn wound healing. It is safe, cheap, and effective for outpatient minor burns.

Step 3 - Cover the wound

• Use a non-adherent gauze dressing (e.g., Xeroform, Mepitel, or plain petroleum gauze) over the topical agent.
• Change dressing once daily (or 2-3x/day if using bacitracin).
• Do not use fluffy cotton-only gauze directly on the burn as fibers can embed in the wound.

What NOT to Apply

• Ice - causes further tissue damage (frostbite on injured skin)
• Butter, oil, toothpaste, egg whites - trap heat, increase infection risk
• High-potency corticosteroids - no benefit, can impair healing
• Neomycin-containing products (Neosporin) - risk of contact dermatitis

When to Seek Medical Attention Urgently

• Burns on the face, hands, feet, genitalia, or joints
• Full-thickness appearance (white/gray/leathery, painless)
• Signs of infection: increasing redness spreading beyond the burn edges, swelling, pus, foul odor, fever
• Burn involves >10% body surface area in an adult (or >5% in a child/elderly)
• Circumferential burns (can restrict circulation)
• Burns from electricity or chemicals
• No improvement or worsening after 48 hours

• Rosen's Emergency Medicine, Local Wound Therapies section
• Roberts & Hedges' Clinical Procedures in Emergency Medicine
• Pfenninger & Fowler's Procedures for Primary Care