Chemical Burns

Chemical Burns Overview

A chemical burn is irritation and destruction of human tissue caused by exposure to a chemical, usually by direct contact with the chemical or its fumes. Chemical burns can occur in the home, at work or school, or as a result of accident or assault. Although few people in the United States die after contact with chemicals in the home, many substances common in both living and storage areas can do serious harm.

Many chemical burns occur accidentally through misuse of products such as those for hair, skin, and nail care. Although injuries do occur at home, the risk of sustaining a chemical burn is much greater in the workplace, especially in businesses and manufacturing plants that use large quantities of chemicals.

Most chemical burns are caused by either strong acids or strong bases (for example, hydrochloric acid or sodium hydroxide). Acids damage and kill cells by coagulating cells while bases liquefy cells. Prolonged exposure can severely damage human tissues and, if the patient survives, leads to scarring and disability. Other chemicals like oxidants and certain metals may also produce similar chemical burns. Limiting the time of exposure to any of these chemicals can greatly reduce their damaging effects.

Unfortunately, some chemical burn agents are designed to harm people (chemical agents used in wars and in terrorist attacks). It is not the scope of this article to cover these agents.

Chemical Burn Causes

Most chemicals that cause burns are either strong acids or bases. A glance at the medical information on the labels of dangerous chemicals usually confirms the expected toxicity. Common sense precautions and consumer education can reduce the risk of injury. A variety of common household products that may cause chemical burns are as follows:

  • Bleach
  • Concrete mix
  • Drain or toilet bowl cleaners
  • Metal cleaners
  • Pool chlorinators

This is just a sample list. Many other products used in the home and at work may contain some amount of chemicals that may cause burns. It is important to keep the labels on the containers in case of an exposure so the medical personnel can know what the patient has been exposed to.

All of these should only be stored in the appropriate containers to prevent accidental ingestion.

heat burn

Burn Types and Symptoms

Inhalation of smoke and toxins may cause death!

The severity of a burn determines the symptoms a person who is burned experiences.

  • First-degree burns cause red skin and local pain only. Sunburn is an example of a first-degree burn.
  • Second-degree burns cause blisters and have more pronounced swelling. The skin may slough (peel).
  • Third-degree burns cause white or black charred skin and loss of pain sensitivity (insensate) because of nerve damage in the deeper tissues.
  • "Burn or smoke-exposed" patients may develop shortness of breath; inhalation of smoke and toxins may cause death, even if they have little or no skin burns.

Chemical Burn Symptoms

All chemical burns should be considered potential medical emergencies.

Most chemical burns occur on the face, eyes, hands, arms, and legs. Usually a chemical burn will be relatively small and will require only outpatient treatment. Chemical burns can be deceiving, however. Some agents can cause deep tissue damage that is not readily apparent when people first look at it.

  • Tissue damage from chemical burns depends on several factors.
    • The strength or concentration of the agent
    • The site of contact (eye, skin, mucous membrane)
    • Whether swallowed or inhaled
    • Whether or not skin is intact
    • With the quantity of the chemical
    • The duration of exposure
    • How the chemical works
    • The length of time to washing (decontamination)
  • Signs and symptoms of chemical burns include the following:
    • Redness, irritation, or burning at the site of contact
    • Pain or numbness at the site of contact
    • Formation of blisters or black dead skin at the contact site
    • Vision changes if the chemical gets into the eyes
    • Cough or shortness of breath
    • Vomiting
  • In severe cases, a person may develop any of the following symptoms:

Chemical burns can be very unpredictable. Death from a chemical injury, although rare, can occur.

When to Seek Medical Care

Once all immediate danger has passed and the person has completed basic first aid (removed from the chemical source, contaminated clothing removed, and, if skin or eyes involved, extensive rinsing with water in most situations), a doctor, if immediately available, should review the injury and the chemical involved to make sure the patient needs no further emergency treatment. If a potential problem remains, the doctor can arrange appropriate treatment or will direct the patient to go to a hospital's Emergency Department.

Any chemical burn can be a legitimate reason to summon emergency medical help if no doctor is immediately available. Always err on the side of safety and call 911 if the severity of the injury is unknown, if the medical stability of the person injured is not clear, or if there are any concerns about a chemical injury.

Emergency personnel are trained to assess the extent of a chemical burn, begin treatment, and transport victims to the most appropriate hospital.

Emergency officials also may determine the need for more involved decontamination of both the patient and the accident site prior to going to the hospital. It is possible that the patient needs further decontamination before arriving at the hospital. As much of the following information as possible needs to be related to the 911 dispatcher:

  • Number and location of the injured person or people
  • Mechanism or nature of injury (how it happened)
  • Whether emergency personnel can reach the victims (are victims trapped?)
  • Name, strength, and volume or quantity of the chemical causing the burn (give a container or its label of the chemical to emergency personnel, if possible)
  • Length of time of contact with the chemical

Chemical Burn Diagnosis

In the emergency department, a person can expect the following:

  • Initial evaluation and stabilization
  • Rapid evaluation of the chemical's ability to damage tissue
  • Determination of the extent of injury
  • Blood tests and other studies to determine if the patient should be admitted to the hospital
  • Determination of additional injuries and treatment

Chemical Burn Treatment

Most people with minor chemical burns do not need to be admitted. Most can go home after arranging follow-up care with a doctor. Patients with major chemical burns however, need to be admitted to a hospital. Ingestion or inhalation of chemical burns may need to be admitted for observation, depending on the potential severity of tissue damage.

Chemical Burns Self-Care at Home

Begin basic first aid. Immediately call 911 if a person has a severe injury, any shortness of breath, chest pain, dizziness, or other symptoms throughout the body. If you are aiding an injured person with these symptoms, lay the person down and immediately call 911. Protect yourself and make sure that you are not exposing yourself to the same chemical.

  • Remove yourself or the injured person from the accident or exposure area. Take appropriate care not to cause further injury to the patient.
  • Remove any contaminated clothing.
  • Wash the injured area to dilute or remove the substance, using large volumes of water. Wash for at least 20 minutes, taking care not to allow runoff to contact unaffected parts of anyone's body. Gently brush away any solid materials, again avoiding unaffected body surfaces.
  • Especially wash away any chemical in the eyes. Sometimes the best way to get large amounts of water to the eyes is to take a shower. If there is an eye wash station nearby (usually fond at work sites), follow the simple instructions to rinse out the eyes.

Chemical Burn Medical Treatment

Specific medical treatment depends on the chemical that the patient was exposed to. Some of the general steps taken to medically treat chemical burns are as follows:

  • IV fluids may be needed to normalize blood pressure and heart rate as any type of burn (fire, chemical, sun exposure) often results in dehydration of the patient.
  • The IV access may also be used for any medications needed to treat pain or protect against infection.
  • Decontamination will begin (likely water irrigation).
  • Some people may be an antidote to counteract the chemical, if appropriate.
  • Antibiotics often are not needed for minor chemical burns.
  • Wounds will be cleaned and bandaged with medicated creams and sterile wraps as needed.
  • Consultation with other medical specialists may be done if indicated.
  • Pain in a burn can often be severe. Adequate pain control will be addressed by the doctor.
  • If there is any indication of breathing problems, a breathing tube may be placed in the patient's airway to help maintain the airway and provide adequate ventilation.

Chemical Burns Follow-up

After leaving the emergency department, call the designated doctor within 24 hours to arrange follow-up care. Patient's should call sooner if any new problems or concerns arise.

Chemical Burns Prevention

  • Secure all chemicals, in and out of the home, in locked cabinets or out of the reach of children.
  • People should  always follow directions and safety precautions on the label provided by the manufacturer when using any chemicals.
  • Wear safety gloves clothing and eye protection when using most chemicals, and remember - safety first!

Chemical Burns Prognosis

Most chemical burns are minor and can be treated without causing long-term problems. Some burns, however, cause significant scarring or other medical complications. Some of the chemical burns that have a more guarded outlook are ingested and inhaled chemicals that may cause burns. These burns can lead to permanent disability or death.

Burns in the eye can lead to blindness.

Chemical Burn Pictures

Burns, chemical. Chemical burn of the skin.
Burns, chemical. Chemical burn of the skin. Click to view larger image.

Burns, chemical. Chemical burn of the eye.
Burns, chemical. Chemical burn of the eye. Click to view larger image.

Reviewed on 11/20/2017

Medically reviewed by John A. Daller, MD American Board of Surgery with subspecialty certification in surgical critical care

REFERENCES:

Cox, Robert D., MD, PhD. "Chemical Burns." Medscape. Updated Oct. 6, 2015.
Dire, Daniel J., MD, FACEP, FAAP, FAAEM. "CBRNE - Chemical Warfare Agents." Medscape. Updated Mar. 23, 2016.

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