Chemical burns occur frequently in the United States. Every year, chemical burns account for 3 to 6% of burn center admissions. Chemical burns may occur in the home as a result of accidental exposure, but occur more frequently in the workplace. Chemicals are also sometimes used as a weapon in an assault. Although chemical burns are not generally fatal, they can result in serious injury.

Most chemicals responsible for serious injuries are either strong acids or strong bases. Examples of such chemicals commonly present in homes are bleach, metal cleaners, toilet bowl or drain cleaners, and pool chemicals i.e. chlorinators. In the workplace, many chemicals are used that can result in injury, such as nitric acid, hydrofluoric acid, acetic acid, sulfuric acid and others.

Chemical burns can be deceiving; they may not cause apparent injury at first glance, and injuries may evolve over time. Chemical burns typically affect the eyes, face, arms and legs. Chemicals may also be ingested or inhaled. All chemical burns should be assessed by a physician. In assessing damage or potential damage from a chemical burn, the physician will want to know the following:

• what type of chemical was involved, including concentration and strength
• how long the victim was exposed to the chemical
• how much chemical was involved in the exposure
• whether the chemical was inhaled or ingested
• site of contact and whether skin is intact at site of contact

Signs and symptoms of a chemical burn injury may include:

• Cough or shortness of breath if the chemical was inhaled
• Blister formation or necrotic (dead) tissue at the site of chemical contact
• Vision changes/loss of vision if the chemical exposure involved the eyes
• Pain, redness, irritation or burning at the site of chemical contact
• Headache
• Weakness or dizziness
• Changes in blood pressure
• Seizures
• Dyspnea (difficulty breathing)

Treatment of chemical burn injuries is dependent upon the extent of injury. Most chemical burns are minor and can be treated on an outpatient basis. In cases of severe chemical burns, the victim will need to be treated in hospital. Treatment may include intravenous fluids to help or prevent dangerous drops in blood pressure. Chemical burns are often copiously irrigated with water to ensure that all of the chemical is removed. Pain medications may be needed if burns are severe, and narcotics may be administered for severe pain. If an antidote to the chemical is available, this will be administered. Breathing will be assessed and, in the case of a severe chemical inhalation injury, a breathing tube may be necessary to assist with breathing until the lungs can heal. If the eyes are damaged, an ophthalmologist will be consulted. In cases of ingestion of a caustic chemical, a gastroenterologist will be consulted. Plastic surgeons may also be consulted if burns are severe.

Although most people survive chemical burn injuries, scarring can be significant, requiring surgery and rehabilitation. The best way to avoid chemical burn injuries is through prevention. All chemicals should be properly labeled and stored, whether they are in the home or the workplace. In the workplace, emergency preparedness should be practiced. Chemical burn injury treatment is dependent upon the severity and extent of injury, and may range from self-care to outpatient treatment to admission to hospital.