How do you treat an infected burn

Treatment of burns

Treatment for burns depends on the degree of injury. If the extent is small, cooling or moist compresses are often sufficient.

Short version:

  • First degree burns can be treated with creams and lotions.
  • Second-degree burns lead to burn blisters, which are treated with bandages and, under certain circumstances, by opening the blisters.
  • Deep burns, on the other hand, usually require hospitalization. In addition to the treatments already mentioned, antibiotics against wound infections are also used here. In addition, autologous skin transplants are surgically performed for deep burns.

How to treat degree burns?

In the case of first-degree burns, cooling with gels, lotions or moist compresses is sufficient. Skin care with oily ointments, moisturizing lotions or creams can be used later. The cooling provides relief from pain and - if present - from itching.

++ More on the topic: degrees of combustion ++

How to treat second degree burns

In the case of second degree burns, small blisters should be left untouched if possible and covered with a dry gauze compress. If there is a suspicion of an infected bladder or if there is a risk of unwanted damage to bulging, annoying bladders, such as those in the vicinity of joints, opening the burn bladder can make sense.

How can burn blisters open properly?

The opening of the bladder should always be done under sterile conditions. Small burns can then be treated with an ointment bandage. It is important to ensure that the wound does not stick to the wound pad. In the case of open blisters, the wound must first be cleaned well with cool water or physiological saline solution.

The wound is then disinfected with a wound antiseptic. For larger burn wounds, a bandage with antimicrobial prophylaxis can be applied. Sterile wound honey is also suitable for antimicrobial wound care and can help promote the healing of burns.

How often should a bandage be changed?

Usually, the dressing is changed at shorter intervals of 12–48 hours in order to ensure local germ reduction and to check the degree of burns again and again. After a few days, the control interval can be extended depending on the clinical picture of the wound.

With the development of new synthetic and semi-biological skin substitute materials, an alternative wound care for second degree burns is achieved. The advantages lie in faster wound healing, a lower infection rate in some cases, a pain-relieving effect and the elimination of frequent dressing changes.

How is the healing process going?

As some of them remain on the wound (7-14 days) or are fully resorbed until epithelialization, i.e. the complete restoration of normal skin, early outpatient treatment is possible. These materials are therefore particularly suitable for children and patients who are difficult to manage for psychological or neurological reasons.

Grade IIa burns can be expected to heal largely without scars within two weeks. If there is no healing after this period, this is a possible indication of a deeper burn that must be treated surgically.

How are deep burns treated?

Deep burns, such as those in grade IIb, usually require hospitalization. Depending on the clinical severity, the wounds are treated conservatively with antimicrobial (against germs) ointments and classic bandages or surgically with a skin substitute.

Burn wounds represent an extremely high risk of wound infections. After about a week, any large open burn wound is considered infected. Staphylococcus aureus, Pseudomonas aeruginosa, Proteus, Klebsiella, Candida albicans and Clostridia are among the most common wound germs.

An infection of the wound with these germs cannot be completely prevented even with the preventive use of antibiotics. The aim of treatment is therefore to keep the number of germs in the wound as low as possible.

Skin graft

If the epidermis and dermis have been completely destroyed by the burn, the necrotic (dead) skin must first be removed (necrectomy) and the defect surgically covered with a skin graft. It is preferred to use autologous skin transplants.

With autologous skin transplants, skin is typically removed from a healthy area of ​​skin on the thigh and then used to cover the burn wound.

Grade III burns must be treated in hospital in any case, as they also require surgical treatment.

Follow-up and follow-up treatment

Signs of infection and a lack of healing require continuous inspection of the burn wound. The longer it takes to rebuild the skin, the worse the functional and cosmetic result. If healing takes longer than three weeks, larger scars and scar contractures can be expected.

Important: Before the scar has completely healed, it should be protected from direct sunlight. If this is not done, there is a risk of hyperpigmentation.

In principle, every wound that heals on the surface benefits from being cared for with a moisturizing cream or ointment until the epidermis is completely regenerated.

+++ More on the topic: Burns - Classification & First Aid +++

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Dr. med. Stefanie Sperlich
Editorial editing:
Dr. med. Christian Maté

Status of medical information:

AWMF-S1 guideline: Guideline for thermal and chemical injuries of the German Society for Burn Medicine, as of 2010

Probst W: wound management. Wissenschaftliche Verlagsgesellschaft mbH, 2nd edition 2010

Voggenreiter G: wound therapy. Georg Thieme Verlag, 2nd edition 2008

Simon, Arne, et al. "Medical honey for wound care — still the‘ latest resort ’?." Evidence-based complementary and alternative medicine 6.2 (2009): 165-173.

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ICD-10: T20