especially if desquamation developed after applying TCS.6,7 The advisors acknowledged a lack of evidence for recommending one particular dressing over another for treating moderate to severe ARD cases.6,7 Wound dressings that maintain a moist wound bed and control exudate while not adhering to the wound bed are widely used.6,7,33,64-69 Depending on the condition and level of exudate, various dressings may be used, such as a hydrocolloid, a foam dressing, or a non-adherent silicone-coated dressing.6,7,64-69 Silicone-based agents may have anti-inflammatory properties and are available as a gel or coated wound dressing.64-68 Dressings comprising a hydrogel may offer soothing and cooling.6,7 The frequency of dressing changes depends on exudate level and is typically every third day.6,7
Clinically manifest secondary bacterial infections may be treated with oral antibiotics based on microbial sensitivities. Still, prophylactic topical antibiotics are generally discouraged for antimicrobial stewardship preventing antibiotic resistance.6,7 Topical hypochlorous acid (HOCl), available as a liquid, spray, or gel, is highly active against bacteria, viruses, and fungal organisms, and has favorable effects on fibroblast and keratinocyte migration.70
Silver sulfadiazine cream to the desquamated region may be used until complete healing, although evidence is lacking.71-73 Although silver sulfadiazine cream is safe, it may slow down re-epithelization.72 A pseudo eschar may form, which requires debridement.72 The use of a silver-containing dressing for secondary infected moist desquamation may be a more favorable option than a cream.73
Experience with a sodium carboxymethylcellulose dressing in partial-thickness burns showed that, when left on the burn for a prolonged period, the dressing developed a parchment-like structure; and once the underlying wound had re-epithelialized, it still allowed for easy removal from the wound site.74,75 This type of dressing is also available as a silver-containing dressing for infected wounds.75
