Acid burn

An acid burn is a chemical skin injury. Such burns are more common in production than in everyday life. However, no one is immune from such injuries.

What are the differences between acid burns and how to treat such injuries correctly so as not to worsen the situation? How to behave when injured by acid?

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Epidemiology

Acid burns account for approximately 10-15% of all burn injuries. Approximately 60% of such cases are observed at work, 30% at home and 10% as a result of deliberate hooliganism.

Men get acid burns 3-4 times more often than women.

According to statistics, in most cases people get injured as a result of exposure to the following substances:

• battery acid;
• sulfuric and sulfurous acids;
• hydrochloric acid;
• acetic acid;
• chromic acid;
• nitric acid.

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Causes acid burn

Acid burns are damage to the skin or mucous membranes as a result of the aggressive effects of acids. Most often, people get burns from aggressive substances that are usually freely available (acetic, hydrochloric acid, etc.).

Damage can be sustained both in everyday life – at home, when treating rooms, dishes, when cleaning plumbing – and in production, especially in chemical industry enterprises. In about 40% of cases, children receive burns.

Acids can be different, depending on the degree of impact on tissues. The strongest are substances with a reaction of the environment (hydrogen ion concentration) less than 2.

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Pathogenesis

The pathogenesis of the action of acids on tissues may vary. In most cases, when damaged by acid, tissues change functionally and organically. As we have already said above, acidic substances can damage tissues already at a pH level of less than 3.

The degree of burn and tissue changes is directly dependent on the following factors:

• from the duration of contact with acid;
• from the properties of the acid and its ability to penetrate deep into the tissues;
• from the scale of the damage;
• from the reaction of the environment (pH) and the concentration of acid.

When in contact with acid, hydrogen ions cause drying of epithelial cells, which leads to the formation of a scab and coagulative necrosis of tissues. Edema and hyperemia occur, the epidermal layer comes off, ulcers and necrotic elements appear. The natural release of heat that occurs in response to an acid burn further increases the damage to the layers of the skin or mucous membranes.

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Symptoms acid burn

In most cases, the first signs of an acid burn are detected immediately after exposure to the substance, but sometimes they can only be noticed after a couple of hours or even a day. This is the main insidiousness of acids: symptoms of tissue layer destruction can appear even after the skin has finished contacting the chemical.

As a rule, a dry and dense crust forms on the area of skin affected by the acid – a scab, which has a clear difference from the surrounding tissues, both in color and in structure.

• A burn of the skin with acid usually does not have too deep penetration into the tissue layers. The scab itself has a light shade from the beginning of its formation, gradually acquiring a dark color. In some cases, for example, when damaged by nitric acid, greenish-yellow spots may appear on the surface of the skin. When exposed to hydrochloric acid, gray lesions may form, the action of carbolic acid is accompanied by the appearance of a white scab.
• An acid burn of the eye is one of the most complex types of damage to the organ of vision. Such a burn is accompanied by photophobia, severe pain, spasm of the eyelids, hyperemia, swelling of the eyelids and conjunctiva, deterioration of vision regardless of the degree of damage. The formed scab has a light grayish or yellowish color. The conjunctiva turns pale and swells. The cornea becomes matte, and in the case of a particularly severe burn - "porcelain".
• An acid burn on the face may not immediately manifest itself: the damage worsens over 20-30 minutes, and the symptoms increase. Mild tissue damage is accompanied by redness and a burning sensation. Blisters from an acid burn rarely occur; more often, a scab, which we mentioned above, immediately forms.
• An acid burn of the esophagus occurs as a result of swallowing chemically active substances. Signs of a burn usually appear immediately. These may include pain behind the breastbone (especially when swallowing), vomiting attacks (often with blood), and increased salivation. The condition may worsen and be complicated by laryngeal spasm and an attack of suffocation. Severe damage to the esophagus with deep tissue necrosis may cause perforation and mediastinitis.
• Acid burns of the respiratory tract are relatively rare, as the respiratory system is more often affected by vaporous and gaseous substances. However, such damage is possible, for example, with accidental ingestion or inhalation of acid vapors. Chemical trauma is accompanied by difficulty breathing, chest pain, and increased body temperature. Asphyxiation attacks and laryngeal stenosis may occur. With intense damage, pulmonary edema and cardiac disorders develop.
• A burn of the tongue with acid usually occurs against the background of damage to the oral mucosa. Such a burn is rarely deep, since the acid that gets into the mouth is most often immediately spat out. Because of this, most burns occur on the tip of the tongue, not on the root. When the tongue is burned with acid, coagulation necrosis develops on the mucous membranes, which is a dense film of brown, yellowish or grayish color (depending on the damaging acid). The resulting film is tightly connected to the underlying layer of tissue.

The patient complains of sharp pain in the tongue and a burning sensation.

Signs of burns from different types of acids

Hydrochloric acid burn	The scab is soft and yellowish-brown at first, but quickly dries and becomes dense. After the scab comes off, a granulation area is formed, sometimes with signs of bleeding.
Burn with citric acid (concentrate)	Redness and swelling of the tissues are observed, without the formation of a scab.
Salicylic acid burn	The scab is brown in color and quickly falls off, revealing a hyperemic, bleeding surface.
Salicylic acid burn on face	It is accompanied by a sensation of itching, severe swelling, and the formation of a pinkish scab.
Boric acid burn	No symptoms.
Nitric acid burn	The scab is light, yellow-green or yellow-brown in color, with clear boundaries.
Formic acid burn	The skin first turns white, then becomes covered with a kind of frost, after which the skin takes on the appearance of wax. A red border line forms around the affected area. The burn is accompanied by severe pain.
Hyaluronic acid burn	No symptoms.
Lactic acid burn	Redness, itching of the skin, burning sensation.
Tartaric acid burn	Destruction of the mucous membrane, swelling, pain, formation of a white film.
Burn from phosphoric acid	The skin turns red, then white, and a dirty-colored scab forms. Penetration is usually shallow.
Sulfuric acid burn	The skin turns white, then yellow, thickens, and then a brownish scab forms.

Symptoms of an acid burn may vary depending on the duration of contact with the chemical and its concentration. Mucous tissues are more affected than the skin surface. All of this must be taken into account when making a diagnosis and determining the extent of the burn.

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Complications and consequences

Acid eye burns can lead to serious complications:

• cicatricial changes and corneal edema;
• increased intraocular pressure.

All this in the future can result in the development of glaucoma, corneal perforation, cataracts, as well as partial or complete loss of visual function.

Burns of the mucous membranes often lead to severe bleeding, perforations and ruptures.

The damaging effect of acidic substances on the skin is accompanied by dehydration, active chemical reactions and protein folding, destruction of cellular structures. As a result of these processes, various-scale tissue necrosis develops, scars and contractures are formed. Motor function is often impaired, and as a result of damage to nerve endings, skin sensitivity worsens or disappears.

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Diagnostics acid burn

When diagnosing internal acid burns, the following tests are mandatory:

• blood pH assessment;
• determination of blood type and Rh factor;
• the amount of hemoglobin in the blood;
• state of the blood coagulation system;
• serum electrolyte concentration;
• general urine analysis.

The listed laboratory tests provide information about the presence of internal bleeding, intoxication of the body, and the functionality of vital organ systems.

Instrumental diagnostics involves the use of the following methods:

• X-ray (allows to determine the presence of a burn of the respiratory or digestive tract);
• computed tomography (helps to detect perforation in cavities);
• endoscopy (advisable only during the first 12 hours after an internal acid burn; in addition to diagnostics, it provides tube feeding to the victim).

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Differential diagnosis

Differential diagnostics of acid burns and tissue damage caused by alkaline solutions is carried out as follows:

• with acid burns, proteins coagulate, forming a scab that prevents the acid from penetrating into deeper layers of tissue;
• In alkaline burns, protein hydrolysis is observed without the formation of a scab, which causes deeper tissue damage.

Treatment acid burn

Treatment of an acid burn is longer than for regular burns. The crust (scab) that forms usually falls off on the 10th to 14th day. After that, the wound surface is exposed, with sluggish signs of granulation and subsequent epithelialization.

Acid burns leave obvious deep scars.

In addition to damaging the skin, acids can cause burns to the mouth, digestive system, and organs of vision.

What to do if you get an acid burn?

Unfortunately, in a panic, the actions of the victim or those around him may be incorrect. In most cases, people use means that are appropriate only for thermal burns, which often only worsens the situation.

What is the treatment for acid burns?

• If an acidic substance gets on your clothing, you must immediately remove it, trying to reduce contact between your skin and the wet fabric.
• The skin should be immediately cleaned of any acid that has come into contact with it by rinsing (thoroughly, for at least 15-20 minutes!) under running water. If rinsing is not done immediately, but a few minutes after contact with the acid, then the rinsing time should be increased to 40-60 minutes.
• You cannot wipe your skin with napkins, either dry or wet.
• If after rinsing the pain and burning sensation do not stop, then the procedure should be continued.
• After rinsing, proceed to neutralize the acid. As a rule, alkali solutions are used for this (for example, a solution of laundry soap, ammonia or baking soda).
• If acid gets into your eyes, you must immediately rinse them with water (you can use milk or a 2% solution of baking soda) and call an ambulance.
• If acid gets into the esophagus, you need to drink a large amount of liquid, preferably with the addition of baking soda. Consulting a doctor is mandatory.

In what cases is it necessary to urgently seek medical help:

• if the victim shows signs of shock (sharp paleness of the skin, shallow breathing, loss of consciousness);
• if the damage is large (for example, with a diameter greater than 1 dm);
• if internal organs, eyes, esophagus, genitals are affected;
• if the victim complains of severe, unbearable pain.

The doctor will first prescribe medications that will eliminate painful and unpleasant sensations in order to avoid pain shock:

	Dosage and method of administration	Side effects	Special instructions
Ibuprofen	In the form of tablets of 300-600 mg up to 4 times a day.	Digestive disorders, stomach pain, tinnitus, insomnia.	Do not use during pregnancy, in childhood (under 6 years), in case of diseases of the digestive system, or in case of a tendency to allergies.
Paracetamol	In the form of tablets of 0.5-1.5 g up to 4 times a day with a glass of water.	Allergic reactions, drowsiness, nausea.	Use with caution in cases of kidney and liver diseases.
Diphenhydramine	In the form of intramuscular injections, 1-5 ml no more than 3 times a day.	Drowsiness, irritability, decreased blood pressure, nausea, sweating, allergic reactions.	Do not use in pediatrics, as well as during pregnancy and lactation.
Analgin	In the form of intramuscular injections, 1-2 ml of 50% solution up to 3 times a day.	Allergic reactions, with prolonged use - changes in the blood picture.	Do not use for burns of the respiratory tract accompanied by bronchospasm, or for allergic tendencies.

After the acute pain has been eliminated, an acid burn ointment is used for further treatment. Almost any ointment that accelerates tissue regeneration and promotes active healing is suitable. For example, you can use the following preparations:

• Sudocrem is an external agent based on zinc oxide. It disinfects the wound surface, dries it, eliminates weeping, and relieves signs of inflammation;
• Desitin is an ointment with zinc oxide that softens and dries the wound, forming a protective film on its surface;
• Panthenol gel is a preparation that promotes the restoration of damaged tissues, including mucous membranes. Accelerates epithelialization and scarring.

At the stage of wound surface epithelialization, it is important to take vitamins. Their purpose is to speed up the healing process and increase metabolism in the body. Mineral and vitamin complexes are best suited for this, for example:

• Vitrum is an American drug that contains all the substances necessary for the normal functioning of the body;
• Supradin is a multivitamin product that is suitable for both adults and children;
• Multitabs is a Danish drug that perfectly eliminates vitamin deficiency in the body;
• Alphabet is a vitamin complex for the whole family.

When choosing vitamin complexes, it is necessary to pay attention to their composition. To accelerate tissue regeneration, the preparations must contain the following substances:

• Omega-3 fatty acids (eliminate inflammation and initiate the recovery process);
• ascorbic acid (participates in the formation of new cellular structures);
• vitamin A – retinol (prevents the development of infection in damaged tissues);
• vitamin B12 – cyanocobalamin (normalizes the function of damaged nerve endings);
• vitamins D and E (due to their antioxidant properties they enhance tissue regeneration).

The healing process will go even faster if the vitamin preparations contain calcium, collagen and glucosamine.

Physiotherapeutic treatment for acid burns is used only during the rehabilitation period. It includes procedures aimed at improving local blood circulation, preventing complications, and getting rid of tissues that have undergone necrosis. The following methods are usually used:

• ultraviolet rays;
• electrophoresis and diadynamic therapy;
• sessions of therapeutic sleep (transcranial electroanalgesia);
• ultrasound treatment and phonophoresis;
• magnetic therapy (transcranial method);
• aeroionotherapy (with analgesics).

Treatment of acid burns should be carried out in a comprehensive manner, using all possible methods that accelerate healing and alleviate the condition of the victim.

Folk treatment for chemical burns, its safety and effectiveness is a controversial issue, so it is recommended to resort to such methods of treatment only after consulting a doctor. There are many known ways to alleviate a person's suffering from acid burns. For example, you can try the following folk recipes:

• apply a cut aloe leaf to the affected area, or make compresses soaked in aloe juice;
• apply a gruel of freshly grated potatoes to the burn site (preferably at night);
• use compresses from a solution of baking soda;
• apply cabbage leaves ground in a meat grinder to the affected area;
• apply a fresh burdock leaf, previously washed well with soap.

In addition, you can use herbal treatments that are used externally and internally:

• Infuse 1 tbsp of calendula in 0.5 l of boiling water for an hour, filter and apply as a compress to the affected area. Duration of the procedure is 30 minutes;
• collect fresh plantain leaves, wash them well, pour boiling water over them and apply to the surface of the burn, possibly under a bandage;
• Grind 1 tbsp. of cinquefoil rhizome, pour 250 ml of boiling water and leave in a thermos for 2 hours. Filter and use to wash the wound;
• use mumiyo: internally 0.2 g in the morning before breakfast for one week, and externally in the form of a 10% solution (you can make compresses).

It is also useful to drink tea with the addition of St. John's wort, chamomile flowers, and sea buckthorn berries.

Homeopathy is very popular and accessible for use. This method of treatment causes a lot of controversy, but many homeopathic remedies are recognized as effective for burns. Here are just a few of these remedies:

	Method of administration and dosage	Side effects	Special instructions
Traumeel C	In the form of an ointment, apply to the wound surface up to 3 times a day. Duration of therapy is up to 1 month.	Contact dermatitis, allergic reactions.	Should not be used in cases of extensive tissue damage.
Lymphomyosot	10 drops three times a day after meals. Duration of therapy – up to 5 weeks.	Allergic reactions.	Used on doctor's recommendation without restrictions.
Mucosa compositum	For digestive system damage, 2.2 ml intramuscularly, once every 2-3 days. The course of therapy is up to 5 weeks.	Allergic reactions at the injection site.	Not prescribed in the first trimester of pregnancy.
Echinacea compositum	2.2 ml intramuscularly up to 3 times a week for a month.	Dyspeptic disorders, allergic reactions.	Should not be used to treat pregnant women or children under 1 year of age.
Engystol	1 ampoule 1-3 times a week, intramuscularly. Duration of therapy is from 2 to 5 weeks.	Allergy, itching at the injection site.	Not used to treat children under 6 years of age.

Surgical treatment is often prescribed for acid burns. Skin transplant operations are performed on the wound surface, with the transplant being taken from healthy areas of the body and limbs. Most often, this is the back and side of the buttocks, back or chest.

Surgical intervention can also be used after the burn has healed, to eliminate the consequences of tissue damage – scars and unsightly marks.

Prevention

To prevent and avoid acid burns, it is important to follow mandatory safety measures:

• acids and other hazardous substances should be stored only in strictly defined places;
• Do not leave containers with acids open;
• all bottles and canisters containing acid must be identified and labeled;
• hazardous substances must not be stored near food products or medicines;
• any chemicals are stored only in places that are absolutely inaccessible to children;
• when working with acids, protective clothing, gloves, etc. should be used;
• After working with acids, it is necessary to thoroughly wash and ventilate the room.

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Forecast

The prognosis for an acid burn is more favorable than for the same damage caused by alkali. However, it is impossible to accurately predict the consequences of an acid burn: the prognosis depends on the concentration of the substance, the duration of skin contact with the acid, and the type of damaged tissue. Mucous tissues are damaged more severely and take longer to heal.

An acid burn ends favorably if proper and timely first aid is provided.

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