Acid burn

Acid burn refers to chemical damage to the skin. Such burns are more common in production than in everyday life. However, no one is immune from such damage.

What is the difference between acid burns and how to properly treat such injuries, so as not to aggravate the situation? How to behave in case of acid damage?

[1], [2], [3], [4], [5], [6], [7], [8]

Epidemiology

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

Men get burns with acids 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:

• accumulative acid;
• sulfuric and sulfuric acids;
• hydrochloric acid;
• acetic acid;
• chromic acid;
• Nitric acid.

[9], [10], [11], [12], [13]

Causes of the acid burn

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

Damage can be obtained both at home - at home, when processing premises, utensils, when cleaning plumbing - and at the workplace, especially at chemical industry enterprises. About 40% of cases children receive burns.

Acids can be different, depending on the degree of effect on the tissue. The most powerful are substances with a medium reaction (concentration of hydrogen ions) of less than 2.

[14], [15], [16], [17], [18]

Pathogenesis

The pathogenesis of the effect of acids on the tissue may be different. In most cases, with acid damage, tissues change functionally and organically. As we 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 such factors:

• on 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 lesion;
• from the reaction of the medium (pH) and the acid concentration.

In contact with acid, hydrogen ions provoke the desiccation of epithelial cells, which leads to the formation of a scab and coagulation necrosis of tissues. There is swelling and hyperemia, the epidermal layer departs, ulcers and necrosis elements appear. The natural release of heat, which occurs in response to an acid burn, further increases the damage to the layers of the skin or mucous membranes.

[19], [20], [21], [22], [23], [24], [25], [26], [27], [28]

Symptoms of the acid burn

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

As a rule, a dry and dense crust is formed on the skin area affected by acid, a scab that has a clear difference from nearby tissues, both in color and in texture.

• A skin burn with acid usually does not differ too deeply into the layers of tissues. The scab itself from the beginning of its formation has a light tint, gradually acquiring a dark color. In some cases, for example, when affected by nitric acid, greenish-yellow spots may appear on the skin surface. Under the influence of hydrochloric acid, damage can occur in gray, the action of carbolic acid is accompanied by the appearance of a white scab.
• Eye burn acid - this 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, impairment of vision, regardless of the extent of the lesion. The formed scab is light grayish or yellowish in color. Conjunctiva thus pales, swells. The cornea becomes dull, and with a particularly severe burn - "porcelain".
• The burn of the face with an acid can not immediately manifest itself: the lesion is aggravated for 20-30 minutes, and the symptoms thus increase. Light tissue damage is accompanied by redness and burning sensation. Bubbles with acid burns are rare, most often immediately formed scab, which we mentioned above.
• The esophagus burns with acid due to ingestion of chemically active substances. Symptoms of burns usually appear immediately. It can be pain behind the breastbone (especially during swallowing), attacks of vomiting (often with blood), increased salivation. The condition can worsen and become complicated by a spasm of the larynx and a fit of suffocation. Severe damage to the esophagus with deep tissue necrosis can cause perforation and mediastinitis.
• The burn of the respiratory tract with acid is relatively rare, since respiratory organs are more often affected by vapor and gaseous substances. However, such damage is possible, for example, by accidental ingestion or inhalation of acid vapors. Chemical trauma is accompanied by difficulty breathing, chest pain, fever. There may be attacks of suffocation and stenosis of the larynx. With a saturated lesion, pulmonary edema develops, and cardiac disorders occur.
• The acid burn of the tongue 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 often spits out immediately. Because of this, most of the burns happen at the tip of the tongue, and not at the root. When the tongue is burned with acid, mucosal coagulation develops on the mucous membranes, which is a dense film of brown, yellowish or grayish color (depending on the attacking acid). The resulting film is closely connected to the underlying tissue layer.

The patient thus complains of sharp soreness in the tongue, a burning sensation.

Symptoms of burns with various types of acids

Burn with hydrochloric acid	The scab at first is soft, yellowish brown, but it quickly dries up and becomes dense. After the departure of the scab, a granulation site is formed, sometimes with signs of bleeding.
Burn with citric acid (concentrate)	There is redness and swelling of the tissues, without forming a scab.
Burn with salicylic acid	The corpuscle is brown, which quickly departs and expels the hyperemic bleeding surface.
Face burn with salicylic acid	It is accompanied by a sensation of itching, a strong puffiness, the formation of a pinkish scab.
Burn with boric acid	There is no symptomatology.
Burn with nitric acid	The corpuscle is light, yellow-green or yellow-brown in color, with clear boundaries.
Burn with formic acid	The skin becomes white at first, then covered with the image of hoarfrost, after which the skin becomes a wax. A red border line forms around the affected area. The burn is accompanied by severe pain.
Hyaluronic acid burn	There is no symptomatology.
Burn with lactic acid	Redness, itching of the skin, burning sensation.
Burn with tartaric acid	Destruction of the mucosa, swelling, pain, the formation of a white film.
Burn from orthophosphoric acid	The skin turns red, then turns white, a scab of dirty color is formed. Penetration, as a rule, shallow.
Burn with sulfuric acid	The skin whitens, then turns yellow, compacts, and then a brownish scab forms.

Symptoms of acid burn may differ, depending on the duration of contact with the chemical substance, as well as on its concentration. Mucous tissues are affected more than the surface of the skin. All this must be taken into account when diagnosing and determining the degree of burn.

[29], [30], [31], [32], [33]

Complications and consequences

Acid burns with acid can lead to serious complications:

• scar 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, perforation and perforations.

The damaging effect of acidic substances on the skin is accompanied by their dehydration, active chemical reactions and folding of proteins, destruction of cellular structures. As a result of these processes, multiscale tissue necrosis develops, scars and contractures are formed. Often, the motor function is disrupted, and as a result of damage to nerve endings, the sensitivity of the skin deteriorates or disappears.

[34], [35], [36], [37], [38]

Diagnostics of the acid burn

When diagnosing internal burns with acids, the following tests are mandatory:

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

The listed laboratory studies provide information on the presence of internal bleeding, on the intoxication of the body, on the functionality of vital organ systems.

Instrumental diagnosis involves the use of such techniques:

• Radiography (allows to clarify the presence of a burn of respiratory or digestive tracts);
• computer tomography (helps to detect perforation in cavities);
• endoscopy (it is expedient only during the first 12 hours after internal burn with acids, except for diagnosis, provides probe nutrition to the victim).

[39], [40], [41], [42], [43], [44], [45], [46], [47]

Differential diagnosis

Differential diagnosis of acid burns and tissue damage with alkaline solutions is as follows:

• with acid burns, protein folding occurs with the formation of a scab that does not allow the acid to penetrate into the deeper layers of tissues;
• with alkaline burns, protein hydrolysis is observed without the formation of a scull, which causes deeper tissue damage.

Treatment of the acid burn

Treatment of burns with acid is more prolonged than with conventional burns. Departure of the formed crust (scab) occurs, as a rule, for 10-14 days. After this, the wound surface is exposed, with flabby signs of granulation and further epithelization.

After acid burns, there are obvious deep scars.

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

What to do if burned with acid?

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

What is the help with burns with acids?

• If acidic substance has got on clothes, it is necessary to get rid of it immediately, trying to reduce the contact of the skin and wet tissue.
• The skin should be immediately cleaned of acid that has fallen on them, rinsing (carefully, no less than 15-20 minutes!) Under running water. If the rinsing is carried out not immediately, but a few minutes after contact with the acid, then the rinse time should be increased to 40-60 minutes.
• Do not wipe the skin with napkins, both dry and wet.
• If after washing the pain and burning sensation does not stop, then the procedure should be continued.
• After washing, the acids are neutralized. As a rule, alkali solutions (for example, a solution of laundry soap, ammonia or baking soda) are used for this.
• When acid gets into the eyes, it is very urgent to rinse them with water (can be milk or 2% solution of baking soda) and call an ambulance.
• When acid gets into the esophagus, you need to drink a large amount of liquid, preferably with the addition of baking soda. Referring to a doctor should be mandatory.

When to seek medical help urgently:

• if the victim has signs of a shock state (sharp blanching of the skin, shallow breathing, blurred consciousness);
• if the damage is large (eg, more than 1 dm in diameter);
• if internal organs, eyes, esophagus, genital organs are affected;
• if the victim complains of severe unbearable pain.

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

	Dose and method of administration	Side effects	Special instructions
Ibuprofen	In the form of tablets of 300-600 mg to 4 times a day.	Digestive disorders, stomach pain, tinnitus, insomnia.	Do not use in pregnancy, in childhood (up to 6 years), with diseases of the digestive system, with a tendency to allergies.
Paracetamol	In the form of tablets of 0.5-1.5 g to 4 times a day, with a glass of water.	Allergic manifestations, drowsiness, nausea.	Apply with caution in diseases of the kidneys and liver.
Dimedrol	In the form of intramuscular injections, 1-5 ml no more than 3 times a day.	Drowsiness, irritability, lowering of 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 - a change in the pattern of blood.	Do not use for burns of the respiratory tract, accompanied by bronchospasm, and also with allergic tendencies.

After eliminating acute pain for further treatment, use an ointment from burns with acid. Suitable is almost any ointment that accelerates the regeneration of tissues and promotes active healing. For example, you can use the following drugs:

• Sudokrem is an external agent based on zinc oxide. Disinfects the wound surface, dries, removes wetness, removes signs of inflammation;
• Desitin - ointment with zinc oxide, which softens and dries the wound, forming on its surface a protective film;
• Panthenol gel is a preparation that helps to restore damaged tissues, including mucous membranes. Accelerates epithelization and scarring.

At the epithelization stage of the wound surface it is important to take vitamins. Their purpose is to accelerate the healing process and increase the metabolism in the body. For this, mineral-vitamin complexes are best suited, for example:

• Vitrum is an American preparation containing all the substances necessary for the normal functioning of the body;
• Supradin is a multivitamin that is suitable for adults and children alike;
• Multitabs is a Danish drug that perfectly eliminates the lack of vitamins in the body;
• Alphabet - a complex of vitamins for the whole family.

When choosing a vitamin complex, you need to pay attention to their composition. To accelerate the regeneration of tissues in preparations should be present such substances:

• Omega-3 fatty acids (eliminate inflammation and trigger a recovery process);
• ascorbic acid (takes part 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 antioxidant properties enhance tissue regeneration).

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

Physiotherapeutic treatment with acid burns is used only during the rehabilitation period. It includes procedures aimed at improving local blood circulation, preventing complications, getting rid of tissues that have been necrotic. Typically, the following methods are used:

• ultra-violet rays;
• electrophoresis and diadynamic therapy;
• sessions of therapeutic sleep (transcranial electroanalgesia);
• ultrasound treatment and phonophoresis;
• magnetotherapy (transcranial method);
• aeroionotherapy (with analgesics).

Treatment of acid burns should be performed in a complex, using all possible methods, accelerating healing and alleviating the condition of the victim.

Alternative treatment for chemical burns, its safety and effectiveness is a controversial issue, therefore it is recommended to resort to such methods of treatment only after consulting a doctor. There are many ways to alleviate the suffering of a person with acid burns. For example, you can try the following alternative recipes:

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

In addition, you can use the treatment of herbs, which are applied externally and inward:

• insist within 1 hour of Art. L. Calendula in 0.5 liters of boiling water, filter and apply as a compress to the affected area. The duration of the procedure is 30 minutes;
• collect fresh leaves of plantain, rinse well, pour boiling water and apply to the surface of the burn, you can under the bandage;
• grind 1 tbsp. L. Rhizome root, pour 250 ml of boiling water and insist in a thermos for 2 hours. Filter and use to wash the wound;
• use the mummy: inside 0.2 g in the morning before breakfast for one week, and externally in the form of 10% solution (you can make lotions).

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

Very popular and available to use homeopathy. This method of treatment causes a lot of contradictions, but many homeopathic preparations are recognized effective for burns. Here are just some of these tools:

	Dosing and Administration	Side effects	Special instructions
Traumeel C	In the form of ointment applied to the wound surface up to 3 times a day. Duration of therapy - up to 1 month.	Contact dermatitis, allergic manifestations.	Do not use for extensive tissue damage.
Lymphomyositis	10 drops three times a day after meals. The duration of therapy is up to 5 weeks.	Allergic reactions.	It is used on the recommendation of a doctor without restrictions.
Mucosa compositum	If the digestive system is affected, 2.2 ml intramuscularly, once every 2-3 days. The course of therapy is up to 5 weeks.	Allergic manifestations at the injection site.	It is not prescribed in the first trimester of pregnancy.
Echinacea compositum	At 2.2 ml IM up to 3 times a week, for a month.	Dyspeptic disorders, allergic reactions.	Can not be used to treat pregnant women and children under 1 year.
Engistol	1 ampoule 1-3 times a week, intramuscularly. Duration of therapy - from 2 to 5 weeks.	Allergies, itching at the injection site.	It is not used to treat children under 6 years old.

Often with acid burns, surgical treatment is prescribed. Transplant operations are performed on the wound surface, while the graft is withdrawn from healthy areas of the body and limbs. Most often it is the posterior and lateral surface of the buttocks, back or chest.

Surgical intervention can also be used after healing of the burn, to eliminate the effects of tissue damage - scars and unaesthetic scars.

Prevention

To prevent and prevent burns with acids, it is important to observe mandatory safety measures:

• acids and other unsafe substances should be stored only in strictly defined places;
• Do not leave containers with acids in the open;
• All bottles and jerricans with acid must be identified and signed;
• Dangerous substances can not be stored near food or medicinal products;
• Any chemical substances are stored only in places completely inaccessible to children;
• When working with acids, use protective clothing, gloves, etc .;
• After working with acids, you must thoroughly wash and ventilate the room.

[48], [49], [50], [51], [52]

Forecast

The prognosis of an acid burn is more favorable than the same damage obtained as a result of exposure to alkali. Nevertheless, it is impossible to accurately predict the consequences of acid burns: the forecast depends on the concentration of the substance, on the duration of skin-acid contact, and also on the type of damaged tissue. Mucous tissues are damaged more strongly and heal longer.

The acid burn ends favorably provided that the first and correct first aid is provided correctly and timely.

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