Chemical Burns: Types, Causes, Symptoms, First Aid, Treatment, Prognosis, Complications

A chemical burn, also known as caustic burn, is a type of burn which occurs as a result of an irritant, such as a base/alkaline or an acid. Chemical burn can occur on the skin or eyes. There may be a reaction on the skin or inside the body due to chemical burns. If any chemicals are swallowed by accident, then there can be damage to the internal organs. In case of swallowing the chemicals, patient should immediately check their mouth for any cuts or burns. Patient should also go to emergency room or local poison control center immediately after swallowing the chemical. Immediate medical attention should be sought if someone has suffered from a chemical burn and has lost consciousness.

Classification or types of chemical burns depend on the depth of the chemical burn and the extent of the injury.

Superficial Burn also known as first-degree burn is where there is injury to the upmost layer of the epidermis or skin.

Partial Thickness Injury/ Dermal Injury/ Second-Degree Burn is injury to the dermis or second layer of skin.

Full Thickness Injury also known as third-degree burn is injury to the subcutaneous tissue or the third layer of the skin.

The main cause of chemical burns is acids and bases. Anyone can suffer from chemical burns anywhere, such as work place and at school, where one has to handle different chemical materials. Common products which cause chemical burns are:

• Bleach.
• Car battery acid.
• Ammonia.
• Denture cleaners.
• Teeth whitening products.
• Pool chlorination products.

Infants, older adults, and disabled individuals are at an increased risk for chemical burns, as this group of people will not be able to handle the chemicals properly. Individuals with decreased mobility and who are handling acids without assistance are also at higher risk for suffering from chemical burns.

Symptoms of chemical burns depend on the method in which the burn has occurred. Chemical burn occurring from swallowing chemicals produces different type of symptoms than the chemical burns which have occurred on the skin.

Symptoms of chemical burn depend on:

• Whether the chemical had come in contact with the skin, was swallowed or inhaled.
• The duration of time to which the skin was exposed to the chemical.
• Whether there were open wounds or cuts or whether the skin was intact when in contact with the chemical.
• The strength and the quantity of the chemical.
• The site of contact with the chemical.
• The type of chemical, if it was in gas, liquid or solid form. If the chemical swallowed was alkaline in nature, then there will be burns present on the inside of the stomach, which produces different symptoms than a chemical burn inflicted on the skin.

• Dead or blackened skin, primarily occurring in chemical burns as a result of acid.
• Redness, irritation or burning occurring in the affected region.
• Pain or numbness is felt in the affected region.
• Vision changes or loss of vision occurs if the chemical has come into contact with the eyes.

• Headache.
• Irregular heartbeat.
• Hypotension (low blood pressure).
• Heart attack or cardiac arrest.
• Breathlessness or shortness of breath.
• Coughing.
• Dizziness.
• Seizures.
• Muscle twitches.

Diagnosis of chemical burns is made based on various factors, such as:

• The intensity of pain in the affected region.
• The depth of the burn.
• The amount of damage to the area
• The extent of the swelling present.
• Signs of a developing infection.

• If the chemical burn has occurred on the hands, face, feet, buttocks or groin.
• If the chemical burn is more than 3 inches in length or width.
• If the chemical burn is present over an important joint, such as the knee joint.
• If there is no relief from pain even after taking OTC pain medications.
• If the patient experiences signs and symptoms of shock, such as dizziness, shallow breathing, and low blood pressure.

Immediate first aid is needed for chemical burns, which includes removing or washing off the chemicals which have caused the burn. This is done by rinsing the skin below running water for around 15 to 20 minutes. If the chemical has come into contact with the eyes, then the eyes should be rinsed continuously for at least 20 minutes followed by a trip to the emergency room. Any jewelry or clothing, which has been contaminated by the chemical, should be removed. The burned area should be loosely covered with a dry and sterile dressing/ cloth. If there is superficial burn, then over-the-counter (OTC) pain killers, such as aspirin can be taken. In case of serious burns, immediate medical care should be sought.

Poison control center should be called if there is uncertainty of a certain chemical being toxic. If a person has swallowed a chemical, which is toxic, then he/she may experience burning in the throat and esophagus. It is imperative to call local Poison Control Center immediately and keep the chemical container with you, so that the content label of the chemical container can be read to the Poison Control people. The Poison Control Center will guide the patient or the attendant as to what steps should be taken next.

The initial treatment of majority of the chemical burns on the skin is done by flushing or rinsing the chemical off the affected region by using room temperature water. However, not all chemical burns should be treated in this manner, as some chemical burns worsen when they come in contact with water. Treating the chemical burn correctly is very important for avoiding further complications.

Depending on the severity of the chemical burn, the following treatment modalities are used for treating a chemical burn:

• Anti-itch medications which are medications to relieve itching are given.
• Antibiotics are prescribed to fight any infection.
• Debridement is done to clean and remove any dirt and dead tissue.
• Skin grafting is a procedure where healthy skin from another part of the body is attached to the chemical burn wound.
• Intravenous (IV) fluids are given to maintain hydration.

Burn rehabilitation is needed in case of severe burns. Rehabilitation treatment provides the following treatments:

• Pain management.
• Skin replacement.
• Cosmetic surgery.
• Occupational therapy, where the patient is re-trained to redevelop everyday skills.
• Patient education is provided regarding chemical burns.
• Counseling for the patient is done.

Rinse or flush the burnt region with tap water for a minimum of 20 minutes. Make sure that the water, which is used, does not have a hard spray, as it can cause damage to the burned area. The chemical substance from the burnt area should be removed if possible. The person who is giving first aid should put on gloves to protect themselves from the chemical, before removing it. Any jewelry or clothing which is near/on the burnt area or which has the chemical on it should be removed. Even after flushing the burnt region, the burning sensation is persisting, then the affected region should be further rinsed under water for more 10 to 15 minutes.

There are some chemical burns which worsen if flushed/rinsed with water. So, in case of such chemical burns, the following steps should be taken.

First Aid for Chemical Burns from Sulfuric Acid: In case of chemical burns from sulfuric acid, mild soapy solution should be used if the burns are mild. If it is rinsed with water, then the sulfuric acid feels hot on the skin. If a soapy solution is not available, then huge amount of water can be used to flush out this acid, as it is better to bear the pain and flush out the chemical from the area instead of leaving it on the skin.

First Aid for Chemical Burns from Carbolic Acid/Phenol: Rubbing alcohol should be used first to flush out the chemicals from the skin; however, it should not be used for flushing the eyes. Carbolic acid/phenol is a chemical which does not mix with water, that’s why rubbing alcohol should be used. If the alcohol is not on hand, then large amount of water should be used to flush out the chemical.

First Aid for Chemical Burns from Hydrofluoric Acid: A solution of bicarbonate of soda should be used if the chemical burns have occurred from hydrofluoric acid. A small amount of water should be used to make this solution after which the affected area should be flushed with large amount of water. Burns from hydrofluoric acid are not always visible to the eye, but the affected region should be flushed even if the burns are not visible. Never use baking soda solution for flushing the eyes.

First Aid for Chemical Burns to the Eyes: In case of chemical burns to the eyes, it is important to flush out the chemical using huge amounts of water to help decrease the chances of serious damage to eyes.

• Disfigurement where the chemical burn has occurred.
• Loss of the affected limb can occur.
• Scarring will be present at the site of the burn.
• Infection can develop at the site of the burn.
• Damage to the tissue and muscle occurs.
• Patient can suffer from psychological problems, such as depression.
• Patient can also experience flashbacks and nightmares of the burn incident.

The prognosis of a chemical burn depends on the severity of the burn. Chemical burns which are minor will heal relatively faster with appropriate treatment. Severe chemical burns will require long-term treatment at a specialized burn center. Many patients are able to recover even with severe chemical burns, if they get appropriate treatment on time with rehabilitation.

Chemical burns can be prevented by following safety procedures and by taking precautions when handling chemicals. These precautions include:

• Chemicals should be stored properly and safely after using them.
• It is important to keep chemicals out of the reach from the children.
• Warning labels should be placed on the containers and always put the chemicals in their original containers.
• Chemicals should always be used in a well-ventilated space.
• Try to avoid the use of chemicals as much as possible.
• Always purchase chemicals, which are present in protective containers.
• Always avoid mixing chemicals with other chemicals.
• Always wear protective clothing/gear when handling chemicals.
• Always keep chemicals away from drinks and food.

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