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According to a study, Are parents in the UK equipped to provide adequate burns first aid?, the proper first aid for a burn is to "STOP the burning":

Strip hot clothes and jewelry
Turn on the cool tap
Organize medical assistance
Protect burn with cling film or clean cloth

About the forth point the authors claim that (p 441) it is inappropriate to protect the burn using butter, milk, antiseptics, toothpaste, ointments, or other creams.

Although (92%) 173/188 of parents overall stated they would cover the burn with a clean dry cloth or plastic film, there was a significant difference between ethnic groups. Significantly greater rates of application of inappropriate topical agents were suggested by ethnic minority parents (27% White respondents 42% of Other Ethnicities) ( p = 0.01). Inappropriate answers included butter, milk, antiseptic or other creams, ointment, cooking oil and toothpaste.

The appropriate way is to use a plastic film or clean cloth.

It is certainly well documented that using products like butter or toothpaste is inappropriate, but what is the evidence for the claim that one shouldn't use any other form of (burn) cream or ointment?

The reason for my question is the existence of a variety of burn ointments that claim to help. According to the Vanderbilt Burn Center one can apply for example Bacitracin which is an ointment.

Link to the full study here.

  • What does "inappropriate" mean in this context? Does it mean simply "not the best action", or "actively worsens"? – iamnotmaynard Apr 2 '15 at 17:29
  • @iamnotmaynard: I think it simply means that it is wrong all together. The article is a bout the STOP campaigne to teach parents how to respond to burns. The article discusses responses to questions about how parents would treat a burn and it sounds like it gives percentages for how many parents basically answered wrong by saying that one could apply an ointment or cream. – John Doe Apr 2 '15 at 19:06
  • @Geobits: I could agree that the article isn't very clear on what they mean. But I read it as saying that one should apply any oint or cream. If you look at figures 1 and 2, then that seems to say the same thing. (I am now wondering if this is just a case of health officials trying to teach advanced topics to the general population, so they have dumbed it down.) – John Doe Apr 2 '15 at 19:08
  • @John Doe: it's entirely possible that some ointments are an appropriate treatment for some burns (eg maybe minor ones) at some stage of healing (eg maybe not as first aid). The advice may be not to apply any ointment except on a doctor's advice. – Nate Eldredge Apr 2 '15 at 23:38
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    I was trained not to put any ointments on a burn as First Aid, as they acted to trap in the heat. The Vanderbilt advice is for wound care, not First Aid, so I see no contradiction. This may explain the discrepancy. – Oddthinking Apr 3 '15 at 1:07
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This answer assumes that the claim is about whether you shall put creams and oitments as a first aid in minor burns.

First aid is what you do before/until an ambulance arrives with a paramedic.


Applying creams to minor burns as a first aid:

Based on claims from authoritative medical websites, it is not recommended nor appropriate to apply any types of creams on burns.

National Health Service (NHS), which is the largest and the oldest single-payer healthcare system in the world, mentioned on their website reported in a post:

Cool the burn with cool or lukewarm water for 10 to 30 minutes, ideally within 20 minutes of the injury occurring. Never use ice, iced water or any creams or greasy substances such as butter.

MedlinePlus, which is a National Institutes of Health website, warned in a post to:

not use cream, lotion, oil, cortisone, butter, or egg white.

Many sites advised to put hydrocortisone cream on burn like mayoclinic.org:

Apply moisturizer, aloe vera lotion or gel, or low-dose hydrocortisone cream, which may provide relief in some cases. (unreferenced)

But, it has been warned not to use on burns by Truven Health Micromedex, the official producer of the drug, information delivered by website drugs.com:

This medicine is for use on the skin only. Do not get it in your eyes, nose, mouth, or vagina. Do not use it on skin areas that have cuts, scrapes, or burns. If it does get on these areas, rinse it off right away with water.

Aafp.org advised:

Soak the burn in cool water. Then treat it with a skin care product like aloe vera cream.

The problem with this claim is that aloe vera is a gel not a cream, there is a slight difference, aloe vera gel has been proven to be effective for burns.

Applying ointments to minor burns as a first aid:

Based on claims from authoritative medical websites, it is not recommended nor appropriate to apply ointments on burns.

http://www.stjohn.org.nz/ reported that:

DO NOT apply creams, ointments, lotions or butter to any burn injury because infection may occur and complicate the injury.

The American Academy of Pediatrics, an organization of 57,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults, said in a report:

Do not break any blisters. This could allow bacteria into the wound. Never put grease (including butter or medical ointments) on the burn. Grease holds in heat, which may make the burn worse. It also makes the burn harder to examine by medical personnel later.

Since all claims so far seem authoritative, here is some evidence which show that creams or ointments are not appropriate as a first aid:

In a very notable study by US National Library of Medicine National Institutes of Health, it is reported in PRE-HOSPITAL CARE paragraph, THERMAL BURNS sub-paragraph, that you shall not put any types of ointments or creams, section 10:

enter image description here

The study added also:

Moreover, removal of such substances might also be difficult and painful to the patient.

Some history:

Another study, a review of first aid treatments for burn injuries, was hidden behind a paywall, now it is on my google drive reviewed:

common first aid and pre-hospital treatments for burns (water—cold or warm, ice, oils, powders and natural plant therapies), possible mechanisms whereby they might work and the literature which supports their use.

The study mentioned:

At the time of the earliest first aid recommendations (1880) [3,39,67], it was suggested that burnt surfaces should be protected from air, and anointed well with oil (lamp oil, salad oil, castor oil or carron oil from a chemist) or painted over with grease or butter, with carbolic acid or thymol added to the oily cotton wool dressing. The use of oil was probably based on the common perception at the time that immediate treatment of burns was needed to prevent exposure to the air, not only to alleviate pain [36], but also to prevent further damage as described by Martin in 1886 [39]: ‘‘Fatal damage may be done in a few moments by exposing a badly burnt chest, or abdomen, to the air before anything is ready to cover it with.’’. Oils and fats on the skin form a very effective air barrier. By 1901, the recommendations for first aid treatment of burns/scalds were clearly segregated depending on wound depth [37], with treatment of flour, whiting or powdered chalk recommended for burns where the skin was ‘‘merely reddened’’, compared to covering with oils (carron, olive, salad, linseed, almond or cod-liver), Vaseline1, lanoline or cold cream when the skin was blistered or charred. Around the 1940s belief had changed that local application of oils and ointments to the skin was not beneficial and made secondary treatment by the doctor/surgeon more difficult [68]. Instead, first aiders were instructed to cover the burnwith a clean or sterile cloth and send the patient to hospital or a first aid post (military).

You can read the full study and find appropriate references there.


Conclusion: You shall never use creams or ointments as a first aid for any burn.

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    I think making the distinction between First Aid advice, and on-going wound care is important. It seems to explain the discrepancies. (NHS is about First Aid. Medline Plus recommends ointments, not creams, as after care, but doesn't discuss them as First Aid, etc.) – Oddthinking Apr 3 '15 at 1:13
  • Perhaps quote the following from nlm.nih.gov/medlineplus/ency/patientinstructions/000662.htm -- "Caring for Burns" and "After the burn is cooled, make sure it is a minor burn. If it is deeper, or larger, or on a hand, foot, face, groin, buttocks, hip, knee, ankle, shoulder, elbow, or wrist, seek medical care." – ChrisW Apr 3 '15 at 8:06
  • @ChrisW, done.. – George Chalhoub Apr 3 '15 at 16:38
  • It's the same NIH paper as you referenced later in your answer. My guess is that it's not the fact that it's ointment instead of cream that makes it OK: it's that it's "care" instead of than "first aid" ('first aid' being what you do before/until an ambulance arrives with a paramedic), and explicitly "after the burn is cooled". – ChrisW Apr 3 '15 at 16:45
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    IMO an ideal answer would provide evidence which demonstrates that, when used for first aid, it's either beneficial or harmful. – ChrisW Apr 3 '15 at 17:13

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