Hydrogen peroxide burn

Hydrogen peroxide is a substance known to many: a transparent liquid, colorless and practically odorless, found in almost every home medicine cabinet. As a rule, it is a 3% solution that is used for external treatment of wounds and cuts. Such a solution does not cause significant superficial burns, moreover, it can be used to treat some thermal burn wounds. If you take this drug internally, you can get an internal burn from hydrogen peroxide, since the mucous membrane of the digestive tract is much more sensitive to the effects of chemicals.

An external burn of the skin can be caused by spilling a concentrated solution on the body - perhydrol, which is a 27.5-31% liquid. There is also a technical version of the solution, which has about 40% concentration.

Epidemiology

Hydrogen peroxide burns, according to some data, account for approximately 5% of all chemical burn cases.

The lethal amount of perhydrol consumed (30%) can range from 50 to 100 ml.

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Causes hydrogen peroxide burn

Burns often occur when hydrogen peroxide is used internally, as well as when the solution is handled carelessly, which is used to lighten fabrics, in printing, in aviation, and in medicine.

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Risk factors

Risk factors may include the following:

• work involving the use of concentrated hydrogen peroxide;
• failure to comply with safety regulations at chemical plants;
• storing medicines in places accessible to children;
• accidental ingestion of the solution, breakage of the bottle, etc.

You can also get a burn if you approach hair coloring incorrectly, because some dyes come with a hydrogen peroxide solution with a concentration of 6% or even 9%, which is 2-3 times higher than the concentration of a regular pharmacy solution.

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Pathogenesis

Hydrogen peroxide has the ability to enter into oxidative and reducing reactions with the release of atomic oxygen. Visually, this process can be observed as lightening of pigmented or colored areas. The released oxygen can destroy bacteria. For the human body, the main danger is represented by concentrates - for example, perhydrol, which can cause burns to the skin and mucous membranes.

The majority of hydrogen peroxide burns are caused by ingesting the liquid. When in contact with mucous tissue, the solution decomposes, releasing oxygen, as peroxide is a strong oxidizer. Perhydrol is considered the most aggressive oxidizer.

When exposed to hydrogen peroxide, there is pronounced destruction of the mucous membranes and skin, which can be compared to an alkali burn.

Deep internal burns of the mucous and submucous tissue can damage blood vessels, which creates the risk of gaseous oxygen entering the general bloodstream with subsequent gas embolism of the vascular bed of the brain or heart.

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Symptoms hydrogen peroxide burn

Typically, doctors identify three main signs of a burn from hydrogen peroxide concentrate:

• whitening or reddening of the skin;
• edema;
• the appearance of blisters.

The most complete description of the clinical picture can be obtained by evaluating the different types of peroxide burns separately.

• A hydrogen peroxide burn of the skin is accompanied by paleness of the upper layer, pain of varying intensity (depending on the degree of tissue damage). In more severe cases, blisters and necrosis of the outer covering appear. Scars form when the wound surface heals.
• A hydrogen peroxide burn of the oral cavity immediately reveals itself as severe pain. This occurs when using peroxide with a concentration of more than 6-10%. Upon examination, the area of damage is clearly visible. The color of the affected area is white. Subsequently, wet necrosis is formed, the tissues become loose, which further facilitates the penetration of the chemical substance deep into the body. Scars after healing are usually more massive and deep.
• A burn of the eye with high concentration hydrogen peroxide threatens complete loss of vision in the affected organ. When a regular pharmacy solution gets into the eye, a burning sensation is immediately felt, irritation, "fog" in the eyes, photophobia, lacrimation occur. The conjunctiva turns red, the pain initially increases, then gradually passes (over the course of several hours). When the corneal layer is burned, the latter becomes cloudy, bubbles may appear in the stroma.

When exposed to a solution of higher concentration (over 10%), ulcers and corneal perforations occur.

• A throat burn with hydrogen peroxide occurs when more concentrated solutions are accidentally used than the treatment requires. As a rule, gargling with a 3% liquid does not cause a burn.

If a solution of more than 10% was used for rinsing, then pain, lightening or redness of the mucous membranes, and swelling are observed in the throat. In severe cases, tissues undergo necrosis.

If hydrogen peroxide is accidentally ingested, it can cause a burn of the esophagus and stomach, which often leads to stenosis and the inability to swallow food.

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Stages

Burns caused by concentrated hydrogen peroxide can be divided into several clinical groups, or stages:

• Stage I is characterized by slight redness and swelling of tissues. The affected area is clearly defined. The first signs of stage I are nagging pain and burning;
• Stage II is accompanied by significant redness, destruction of the skin epithelium and superficial layers of tissue, and the formation of blisters. A characteristic sign of stage II is severe pain;
• Stage III is necrosis of the superficial tissue, a radical change in its color, unbearable pain, swelling and hyperemia of the nearby area;
• Stage IV is characterized by the death of the skin, complete necrosis of the underlying fat layer and muscle fibers.

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Complications and consequences

Deep burns with concentrated hydrogen peroxide can lead to undesirable systemic and local consequences:

• shock state, toxemia;
• if ingested – damage to the mucous membrane of the esophagus and digestive tract;
• dysfunction of the urinary system;
• water-salt imbalance;
• coma;
• tissue necrosis;
• in case of eye damage – clouding of the cornea, deterioration or loss of vision.

Remote consequences include gross cicatricial deformation of the affected area, joint contractures, and trophic disorders. These problems often require the intervention of a surgeon or orthopedist.

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Diagnostics hydrogen peroxide burn

Laboratory diagnostics include the following tests:

• determination of blood pH, biochemistry, concentration of electrolytes in blood serum;
• general urine analysis.

When hydrogen peroxide is taken orally, metabolic acidosis may develop. In addition, kidney and metabolic disorders should be excluded.

Instrumental diagnostics may consist of a number of studies:

• X-ray examination of the chest and abdominal cavity to exclude perforation of the digestive tract;
• computed tomography and ultrasound;
• X-ray examination using a contrast agent (to diagnose narrowing of the digestive tract);
• endoscopic examination (relevant during the first 24 hours after internal use of hydrogen peroxide).

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Differential diagnosis

Differential diagnostics are carried out with other types of burns: alkaline, acid, thermal, etc. As a rule, in most cases, if the patient is conscious, he can independently name the substance that caused the burn.

Treatment hydrogen peroxide burn

First aid for a burn with hydrogen peroxide concentrate consists of three stages:

• intensive detoxification measures;
• chemical neutralization;
• symptomatic treatment.

1. The first stage includes abundant rinsing of the skin or stomach (eyes, mouth), depending on where exactly the burn occurred. The probe for rinsing the digestive tract is pre-lubricated with vegetable oil.

Forced diuresis with alkalizing solutions is also relevant. Drinking warm teas, compotes, milk, and non-carbonated mineral waters is suitable. In case of an internal burn, it is recommended to swallow small pieces of frozen water.

1. At the second stage, when metabolic acidosis is detected, the patient is given 4% sodium bicarbonate intravenously by drip, up to 1.5 liters.
2. Symptomatic therapy involves monitoring the victim and prescribing medication that corresponds to the symptoms that have arisen.

In cases of burn shock, the following are prescribed: intravenous administration of Rheopolyglucin (up to 800 ml), 5% glucose solution (up to 300 ml). In addition, the following are administered:

• Atropine 0.1% 1 ml subcutaneously up to 8 times a day;
• Papaverine 2% 2 ml s.c.;
• Platyfillin 0.2% 1 ml s.c.

In case of cardiovascular failure, the following drugs are used:

	Cordiamine	Caffeine
Application and dosage	Prescribed 1-2 ml by injection, up to 3 times a day.	The drug is administered subcutaneously at 100-200 mg up to 3 times a day.
Side effects	Nausea, allergies, redness of the upper body.	Agitation, increased blood pressure, nausea, arrhythmia.
Special instructions	Not for use during pregnancy.	Do not use in hypertension or in old age.

If there is a risk of infection of the burn surface, antibiotic therapy is administered. Most often, penicillin antibiotics are prescribed (penicillin up to 8 million units per day).

For external treatment of the wound surface, use:

	Anesthesin	Levomekol
Application and dosage	Externally 5-10% ointment. Internally for esophageal lesions - 0.3 g up to 4 times a day.	The ointment is applied to sterile gauze and placed on the burn site. The dressings are changed daily until the wound heals.
Side effects	Allergic manifestations.	Allergy.
Special instructions	There are no restrictions on use.	Not recommended for long term use.

As a supportive treatment, vitamins are prescribed:

• B¹² up to 400 mcg;
• B¹ up to 2 ml of 5% medication;
• pyridoxine 5% – 2 ml IM.

Vitamins should be administered separately, without mixing them in the same syringe.

In case of swelling of the laryngeal tissues, aerosol preparations are used:

• novocaine with ephedrine;
• novocaine with adrenaline.

If aerosols are ineffective, a tracheostomy is performed.

At the healing stage, physiotherapy treatment can be used, which helps relieve pain, stop the inflammatory process, and speed up tissue recovery.

• For pain relief, transcranial electrical stimulation methods are used (Transair, Lenar, El Esculap Medteko devices).
• For the correct formation of the scab, a special Geska apparatus is used.
• To restore tissue at the site of damage, the following is used:
  • Khivamat (session 15-20 min, treatment – up to 15 sessions);
  • Franklinization method (session 20 min, treatment – up to 30 sessions);
  • ultraviolet irradiation (10 actions every other day);
  • magnetic therapy (treatment consists of 15 procedures).
• In case of tissue scarring, the following procedures will be relevant:
  • enzyme electrophoresis with lidase, collalysin, up to 15 procedures;
  • paraffin applications;
  • Ultraphonophoresis with hydrocortisone (up to 12 sessions).

Surgical treatment may be prescribed urgently for deep burns of both the outer skin and the digestive system. The operation usually has the following goals:

• restoration of food passage through the esophagus, restoration of swallowing and breathing functions, tracheostomy;
• removal of dead tissue, cleaning of the wound surface;
• dermoplasty;
• amputation in case of complete tissue necrosis and risk of gangrene development.

Surgery is a special treatment method that is used only in extreme cases.

Traditional treatment of burns with hydrogen peroxide

• The area of skin damaged by the burn is washed under running water for at least 15 minutes, after which it is treated with a weak solution of baking soda.
• After washing, a cloth soaked in sea buckthorn oil with the addition of an oil solution of vitamin E is applied to the burned area.
• To speed up healing, it is useful to apply compresses with a strong infusion of coltsfoot and oak bark.
• If you don’t have anything suitable at hand, you can use strong black tea for the compress.

For burns of the digestive tract with hydrogen peroxide, the following recipes are used:

• drink a glass of lukewarm milk with two spoons of honey;
• drink freshly prepared starch jelly.

Herbal treatment can also be used for specific burns of the eyes and mouth:

• in case of an eye burn, rinse it with an infusion of birch leaves and buds (1 tbsp. per 400-500 ml of boiling water);
• apply a compress of clover flower infusion to the affected eye (1 tbsp. per 250 ml of boiling water);
• In case of a burn in the mouth, rinse with a decoction of chamomile or oak bark (1 tbsp. per 300 ml of boiling water).

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Homeopathy

In recent years, homeopathic medicines have gained increasing trust among patients and doctors. The effectiveness of such products is obvious, and the side effects are minimal. The main thing is to strictly adhere to the prescribed dosage.

To treat burns with hydrogen peroxide, you can use the following homeopathic preparations.

	Abropernol	Calendula-Salbe-Heel C	Causticum compositum	Camillene-Salbe-Heel S
Application and dosage	Take 1 tablet three times a day.	Apply twice daily under a bandage.	Take 10 drops three times a day.	Apply to the affected area twice a day, morning and night.
Side effects	Rarely – allergy.	Rarely – allergy.	Rarely – allergy.	Rarely – allergy.
Special instructions	Not allowed for pregnant or breastfeeding women or children.	At the same time, it is recommended to use the drug Traumeel S.	There are no restrictions on use.	Can be used without restrictions.

Prevention

Prevention of burns means observing safety precautions when working with chemicals and concentrated solutions, including concentrated hydrogen peroxide.

• You cannot keep bottles and jars at home that do not have markings and the name of the contents.
• You should not have prolonged contact with the solution, even if its concentration is considered safe.
• Do not store chemical solutions near food storage and preparation areas.
• The first aid kit and any chemical solutions should be kept in places inaccessible to children and mentally unstable family members.
• Under no circumstances should chemical or medicinal liquids be poured into containers that previously held drinks or food.
• Bottles containing chemicals should be carefully resealed immediately after use.

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Forecast

The prognosis of a burn depends on the competent provision of emergency care. If the concentration of the chemical solution is small, and the rinsing is performed as quickly and effectively as possible, then the degree of the burn will be small. Accordingly, the prognosis can be considered favorable.

If the hydrogen peroxide burn was severe, with deep tissue damage, the consequences can be extremely negative.

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