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The Best Ointment for Burns: OTC vs. Rx

burn ointment cartoon

Burns can result from heat, excessive sun exposure, radiation exposure, or contact with chemicals or electricity. Depending on the severity and location, they can range from a minor problem treated at home to a life-threatening emergency requiring medical treatment in a hospital. More widespread and deeper burns may require specialized care at a burn care center. 

A sunburn or minor scald can probably be treated at home. Please continue reading to learn when you need to see a doctor and when it is safe to treat a burn at home. Also, find out what are the best over-the-counter topical antibiotics for burn treatment. 

Can I treat a burn at home?

Burns are classified as first, second, or third-degree based on the severity. A healthcare provider can evaluate the burn and classify it accordingly. Remember, it can take a couple of days for the signs and symptoms of a severe burn to develop.

1st-degree burns are minor and affect only the epidermis (outer layer of skin). Symptoms may include pain and redness.

2nd-degree burns affect the epidermis and dermis (outer and middle layers of skin). They can be very painful with swelling with white or red splotchy skin, and blisters.

3rd-degree burns extend to the fat layer below the skin. The skin may turn black, brown, or white and may appear leathery. Numbness can occur in addition to other symptoms due to destruction of the nerves.

First- and second-degree burns that do not involve more than 10% of the body may not require hospitalization. Second-degree burns on more than 10% of body area or third-degree burns on more than 1% of body area are considered moderate to severe requiring specialized medical treatment. The treatment goal includes pain control,  infection prevention, removal of dead skin, reducing scarring, and maximization of the return to baseline function in burned areas.

Which ointment is best for burns?

The Food and Drug Administration (FDA) in the United States has approved several over-the-counter topical antibiotic ointments to prevent infections in burns and other minor skin injuries. Here is some brief information on the most commonly used products.

Generic bacitracin

Bacitracin is a generic over-the-counter (OTC) topical antibiotic ointment that can be purchased at a pharmacy without a prescription. Bacitracin is widely used to treat minor cuts, scrapes, scratches, and burns. The antibiotic is easily absorbed through burned tissue and stops the growth of bacteria. 

Brand name and generic Neosporin

Neosporin is a topical antibiotic ointment that is available in both generic and brand versions. It is often labeled as “Triple Antibiotic Ointment” because it contains three antibiotics—polymyxin B sulfate, bacitracin, and neomycin. Some formulations of Neosporin contain three antibiotics and an anesthetic pramoxine for pain relief. Besides ointments, Neosporin is also available as a cream. The only major difference between cream and ointment is their oil content. Ointments, with higher oil content, ensure optimal product absorption because they don’t evaporate off the skin. 

Brand name Polysporin

Polysporin is also known as the “Double Antibiotic Ointment” because it contains two active ingredients—polymyxin B and bacitracin (it does not contain neomycin—the third antibiotic found in Neosporin). It is, therefore, a potential treatment option for people with a neomycin allergy.

Which is better for burns—bacitracin or Neosporin?

It is important to talk to your doctor for treatment of burn wounds that are deep or severe. For minor cuts and burns, you can use either medication—bacitracin or Neosporin. Bacitracin prevents bacterial growth. On the other hand, the antibiotics in Neosporin not only prevent bacterial growth but also kill any bacteria that may be already present in the wound

Bacitracin and Neosporin are not covered by Medicare Part D or insurance because they are OTC drugs. However, some plans may cover the generic forms of these topical antibiotics. The other good news is that you can get a BuzzRx discount as long as you have a prescription from your doctor!

Both medications are generally well-tolerated; however, side effects can include contact dermatitis or mild skin irritation. If the treated area becomes red, swollen, or oozes, call your doctor as soon as possible. If you develop signs and symptoms of an allergic reaction, such as hives, swelling of the face, tongue, lips, or throat, or difficulty breathing, call 911 and seek emergency medical care. 

What do doctors prescribe for burns?

In most cases, minor burns can be treated at home and heal in 1-2 weeks. More severe burns require a full physical examination.  Severe burns would require specialized medical treatment that can include oral or intravenous antibiotics, topical antibiotic ointments or creams, wound dressings, surgery, and even skin grafts to cover large wounds. Physical therapy will be vital to regaining movement. Last but not least, emotional support is an essential part of treatment and recovery. The whole process can last for months or even years for extremely severe cases. To treat second and third-degree burns, doctors may use silver sulfadiazine cream (brand name Silvadene), an antibiotic that kills bacteria and prevents their growth. Silvadene is a prescription cream; however, silver sulfadiazine antibiotic is also available in over-the-counter wound care products such as Hydrogel AG.

What is the best over-the-counter product for burns?

Studies have shown that over-the-counter (OTC) topical antibiotics, including Neosporin and bacitracin, can lower infection risk in patients with burns. However, the risk reduction is not significantly higher than common antiseptics such as hydrogen peroxide or placebos (treatment that has no therapeutic value that is used in clinical trials). Also, white petrolatum or petroleum jelly (the ingredient in Vaseline) has been shown to be equally effective in lowering infection rates. The advantage of petroleum jelly is that it is less likely to cause allergic reactions. 

You should keep an OTC ointment for burns in the first aid box at home and work. The best OTC medicine for burns is one that is effective with minimal side effects or reactions. If you previously had an allergy to antibiotics, talk to your doctor or pharmacist about the best topical antibiotic for you. Also, be sure to seek medical care if you notice oozing or green/yellow discharge, as this could mean the wound is already infected.

Remember that OTC antibiotic ointments like Neosporin and bacitracin are for external use only—they should not be taken by mouth, and they should not be used in the eyes or on widespread burns. Also, do not use these medications if you have a history of allergy to any of the listed ingredients. Call your healthcare provider immediately if you develop a rash or any kind of local or systemic allergic reaction or if your condition worsens.

Should I use Neosporin on a burn?

Neosporin (Triple Antibiotic Ointment) is an appropriate treatment option for a minor,  uncomplicated burn. Other potential treatments include bacitracin, Polysporin, or petroleum jelly. You should apply the ointment or cream and cover the wound with a non-stick dressing or pad such as Telfa (not a cotton ball).

How do I heal a burn quickly?

First-degree burns are common from accidental contact with a hot stove, hair straightener, or iron. Sunburns can also cause first-degree burns with redness, tenderness, and mild swelling. These can usually be treated at home. However, proper treatment is necessary to ensure the burns do not leave a scar as well as for pain control while the skin heals

To speed up healing of a first-degree burn, dermatologists recommend:

Put the burned skin under cold water or apply a cold compress for around 10 minutes.

Apply petroleum jelly or an OTC antibiotic ointment 2-3 times a day and cover with a non-stick sterile bandage. 

Do not use toothpaste, butter, or other things from your pantry on the burn, as this can cause infection.

If blisters develop, allow them to heal without popping them.

Take over-the-counter acetaminophen or ibuprofen to control pain and inflammation. Please follow dosage recommendations on the product label to ensure safety and efficacy. 

When the burn heals, protect the skin with sunscreen to minimize scarring.

The importance of getting medical advice

If you are not sure about the severity of your burn, please go to the emergency room immediately. If you are sure that it is a minor, first-degree burn, you can treat it at home. A topical antibiotic ointment or cream can help prevent infection. However, it is best to get medical advice if the burn is on the face or genitalia. You should also consult a doctor if the burn is extensive and you have severe pain, if there is yellow/green discharge or severe blistering, or if the burn does not improve in 1-2 weeks. It is also recommended to get medical advice for older adults, children, and infants with burns of any severity.

References:

1. https://my.clevelandclinic.org/health/diseases/12063-burns

2. https://www.ncbi.nlm.nih.gov/books/NBK536993/

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858851/

4. https://jamanetwork.com/journals/jama/article-abstract/408314

5. https://www.aad.org/public/everyday-care/injured-skin/burns/treat-minor-burns

6. https://www.mayoclinic.org/diseases-conditions/burns/diagnosis-treatment/drc-20370545#