Chemical Burns: Causes, Pathophysiology, Risk Factors, and Treatment

Introduction

A chemical burn is damage caused to the body tissues when exposed to caustic or harmful chemicals. This damage can occur through direct contact with the skin or other parts of the body, through the ingestion of chemicals, or through inhalation. Chemical burns range from mild to severe. Mild burns heal quickly, whereas severe ones can lead to permanent tissue damage, scarring, and even death. Chemical burns can lead to short-term, long-term, and lifelong health problems if left untreated. Timely and accurate management of the damage caused can lead to better treatment outcomes.

What Causes Chemical Burns?

Chemical burns, when contracted with the eyes or any tissue in the body, can destroy the tissue. Sometimes, the damage can go beyond the superficial layers of skin or tissue and can lead to huge damage in the deeper layers. Chemical burns can be more destructive than thermal (heat) burns, as chemicals do stay on the skin for longer periods of time, leading to large-scale destruction. Many harmful chemicals cause chemical burns. Some of the most common ones include the following:

• Battery acid.

• Bleach.

• Detergents.

• Drain cleaners.

• Fertilizers.

• Hair relaxers.

• Metal cleaners and rust removers.

• Paint removers.

• Pesticides.

• Sanitizers and disinfectants.

• Swimming pool chemicals.

• Toilet bowl cleaners.

• Wet cement.

What Happens to the Tissues Following a Chemical Burn?

• Alkaline Agents: These cause liquefaction necrosis of the skin when exposed and can lead to irreversible changes in the protein matrix of the skin. Vascular damage can cause local or systemic effects depending on the severity of the burns.

• Acidic Agents: These result in coagulation necrosis and, eventually, cytotoxicity. Additionally, mucosal or skin changes occur, preventing further toxicity and absorption. Overall, alkaline agents are more toxic than acidic agents, owing to the irreversible changes in protein and tissue damage.

Who Are at Risk of Getting Chemical Burns?

• Young children.

• Old people.

• People with disabilities.

Some Occupationally Related Jobs Like:

• Construction workers.

• Factory workers.

• Farmers.

• Laboratory technicians.

• Mechanics.

• Military personnel.

• Plumbers.

What Are the Symptoms of Chemical Burns?

Chemical Burns on the Skin Cause:

• Blisters or scabs.

• Cracked, dry skin.

• Pain.

• Peeling skin.

• Redness.

• Skin discoloration.

• Swelling.

Chemical Burns to the Eyes Can Lead To:

• Blurry vision.

• Eyelid swelling.

• Pain.

• Redness.

• Stinging or burning.

• Watery eyes.

• Blindness (in severe cases).

Chemical Burns From Ingestion (Swallowing) May Cause:

• Chest pain.

• Cough.

• Difficulty speaking (dysphonia).

• Drooling.

• Hoarseness.

• Low blood pressure (hypotension).

• Nausea and vomiting, or vomiting blood.

• Pain in the mouth or throat (especially when swallowing).

• Perforations (holes) in the stomach, esophagus, or cornea.

• Shortness of breath (dyspnea).

• Upper airway swelling (edema).

What Are the Types of Chemical Burns?

Chemical burns are classified according to the extent and the depth of the injury caused by the burn and are as follows:

• Superficial or First-Degree Burns: Injury to the superficial layer of skin, or the epidermis, is a superficial burn. The area appears red and painful and is usually not accompanied by permanent damage.

• Partial Thickness or Second-Degree Burns: Injury to the second layer of skin, or the dermis, is a partial thickness injury or dermal injury. Blisters and swelling are common findings and may leave scars.

• Full-Thickness or Third-Degree Burns: Injury to the third layer of skin, or subcutaneous tissue, is a full-thickness injury. The area appears black or white. Pain sensation will not be present as the nerves are destroyed.

Chemical burns can be diagnosed by physically examining the extent, depth, and other characteristics on the involved surface. The other routine tests to diagnose burns on the skin or in the eyes or from swallowing a chemical include the following.

• Blood Tests: Swallowing chemicals or direct contact with the skin or eye can absorb the chemicals into the body. A complete blood count (CBC) and other lab tests can assess the kidney, liver, lung, and metabolic function for any type of chemical burn.

• Endoscopy: Swallowing a chemical needs an endoscopic evaluation. A thin, flexible tube with a video camera on one end (endoscope) is entered first into the mouth and down through the esophagus, and the pictures of the throat, esophagus, and stomach can be visualized in a video monitor and thus burnt or damaged tissue can be detected.

• Eye Exam: An ophthalmologist (eye care specialist) checks for chemical burns to one’s eyes. Signs of vision loss and the extent of the burn are assessed. Special dyes are an adjunct to look for areas of damaged tissue in the eyes.

• Imaging: Imaging helps in identifying the damage inside the body by swallowing a chemical, like perforations in the esophagus or stomach. Chest X-ray or CT (computed tomography) scan can help spot internal tissue damage.

How Are Chemical Burns Treated?

• IV (intravenous) fluids are required to normalize blood pressure and heart rate.

• The antidote is given to counteract the chemical in known cases.

• Wounds are cleaned and bandaged with medicated creams and sterile wraps.

• Consultation with other medical specialists may be done.

• Pain from a burn is most commonly severe, and adequate pain management plays an important role.

• In case of breathing problems, a patent airway needs to be established to avoid complications.

• Burns itch while healing and can be worrisome. Special medications are essential to relieve the itching and pain in the affected area.

• Severe burns require surgery. With the help of skin grafting, a piece of healthy skin from other parts of the body or from a donor can be transplanted to replace the damaged tissue.

• Cosmetic or reconstructive surgery is indicated in case of scarring.

• Counseling can help in dealing with the emotional trauma caused due to injury or disfigurement.

What Are the Complications of Chemical Burns?

• Disfigurement.

• Limb loss.

• Infection.

• Scarring.

• Muscle and tissue damage.

• Depression.

• Flashbacks.

• Nightmares.

How Can One Prevent Chemical Burns?

Chemical burns can be prevented by following safety protocols and taking precautionary measures while handling chemical materials, which include the following:

• Keeping the chemicals out of the reach of children.

• Storing chemicals properly and safely after use.

• Using chemicals in a well-ventilated area.

• Leaving chemicals in their original containers with warning labels.

• Avoiding the use of chemicals.

• Avoid mixing chemicals with other chemicals.

• Only purchasing chemicals in protective containers.

• Keeping chemicals away from food and drinks.

• Wear protective gear and clothing when using chemicals.

Conclusion

The outcomes following a chemical burn are determined by the chemical, the extent of the burn, the comorbidity of the patient, and the time taken for the intervention. Superficial burns treated in time have a better prognosis. Counseling and support groups help cope with the emotional trauma in severe cases to cope up with the emotional trauma.