Acid and chemical burns

A chemical burn happens when a corrosive substance reaches the skin, the eyes, the mouth or the airways. It differs from boiling water or fire in one decisive way: the damage does not end at the moment of contact. As long as the substance stays on the skin, it keeps eating into the tissue minute by minute. What matters here is not first aid in general, but first aid immediately.

How it differs from a heat burn

Acids coagulate proteins and form a dense crust that partly slows their progress deeper. Alkalis behave differently: they dissolve fats and proteins and travel further into the tissue the longer they stay on the skin. That is why a household alkali is often more dangerous than an acid, even though it frightens people less.

The substances capable of burning are found in almost every home and most workplaces:

• bleach and chlorine-based cleaners;
• drain, oven, hob and toilet cleaners;
• concentrated laundry detergents and washing capsules;
• ammonia;
• battery acid;
• cement, lime and building mixes;
• acids, solvents and reagents used in industry, farming and laboratories.

The hazard is usually marked on the label with a pictogram and a warning. It is worth reading before you need it.

The first minutes decide everything

The sequence is the same at home and at work.

• Call the emergency number, 112 across Europe.
• Protect yourself: put on gloves and do not touch the substance with bare hands when helping someone else.
• If the product is a dry powder, brush it off the skin first and only then rinse. Powdered lime and cement heat up on contact with a small amount of water and burn harder.
• Remove clothing, jewellery and watches from the affected area: the substance is held in fabric and under rings.
• Rinse under cool running water for at least 20 minutes, and for an alkali or an unknown product for up to an hour or until help arrives. The water should run away from healthy skin.
• Cover the burn with a clean non-stick dressing or cling film, loosely.
• Keep the container or photograph the label: the medical team needs to know exactly what the substance was.

What must not be done: neutralising an acid with an alkali or the other way round, since the reaction releases heat and adds a heat burn to the chemical one; applying creams, ointments, oil, toothpaste or flour; bursting blisters; pulling off fabric stuck to the wound.

If it gets into the eyes

The eye is damaged faster than skin, and here seconds count. Start rinsing at once, without wasting time looking for a special solution: clean running water will do.

• Hold the eyelids apart with your fingers, because the eye will keep closing by reflex.
• Rinse for at least 20 to 30 minutes, directing the water from the inner corner outwards so it does not wash into the other eye.
• Take out contact lenses if they come away easily, but do not interrupt the rinsing for long to do it.
• Do not rub the eye and do not put anything but water into it.

A doctor must see the eye in any case, even if it feels better. An alkali burn is deceptive: a red eye hurts and waters, whereas a severe injury looks the opposite, with the eye turning pale because the vessels have stopped working. Rinsing continues in hospital, guided by the acidity of the tear film.

If it has been swallowed or inhaled

If a corrosive liquid has been swallowed, do not make the person vomit: the substance would pass through the oesophagus a second time and burn the larynx as well. Give nothing meant to neutralise it, no milk with baking soda, no vinegar, no activated charcoal. Rinse the mouth with water, do not force large volumes of drink and call for help immediately.

Urgent signs are drooling, inability to swallow, a hoarse voice, noisy breathing and pain behind the breastbone or in the abdomen. In hospital the oesophagus is usually examined by endoscopy within the first twenty-four hours to establish how deep the injury goes.

If you have inhaled fumes, get into fresh air and open the windows. Coughing and a raw throat after chlorine or ammonia may settle and then, a few hours later, give way to increasing breathlessness, so medical assessment is needed even when things seem to improve.

Substances more dangerous than they look

Hydrofluoric acid turns up in rust removers, wheel cleaners, glass-etching preparations and industrial processes. Its peculiarity is that pain may take several hours to appear, by which time the injury is already deep. It binds calcium in the body, so even a burn of small area can disturb the heart rhythm. Help is needed at once, before any pain begins, and calcium preparations are used in hospital as the antidote.

Cement and lime burn stealthily: the mix gets into a boot or under a knee pad, the person carries on working and discovers the injury hours later, when it has already reached the deeper layers.

Mixing cleaning products is a hazard in its own right. Bleach together with an acidic cleaner releases chlorine, and with an ammonia-based product it releases another irritant gas. Both burn the airways within a few breaths in a closed bathroom.

What happens in hospital and how it heals

The team assesses the depth and area, continues rinsing, checks the acidity on the skin or in the eye, relieves pain and cleans and dresses the wound. Tetanus vaccination status is reviewed. In extensive burns fluids are given intravenously to support blood pressure and kidney function. Antibiotics are prescribed when infection develops, not routinely for everyone.

Deep burns are closed surgically, sometimes with a skin graft. Reconstructive surgery and rehabilitation may be needed later if scars restrict movement at a joint.

At home the wound needs watching. See a doctor promptly if pain increases instead of settling, the surrounding skin becomes red and swollen, discharge with an odour appears, or a fever develops. A fresh scar is kept out of the sun for a year and moisturised daily; itching during that time is normal.

How to prevent it happening again

• Store products only in their original packaging. A cleaner decanted into a soft-drink bottle is the most common cause of serious burns in children.
• Keep household chemicals on high shelves or locked away, and choose packaging with child-resistant caps.
• Work in gloves and safety goggles, and ventilate the room.
• Never mix two cleaning products together.
• At work, know where the emergency shower and the eyewash station are before you need them.

Online consultation

The acute stage of a chemical burn cannot be handled remotely: if a product has reached the skin or the eyes, rinsing and an emergency call come first. An Oladoctor doctor is useful at the next stage.

A consultation can cover what exactly you were burned with and what to expect from that substance, review by photograph how the wound is healing, decide whether a dressing change or a face-to-face visit is needed, discuss scar care and recovery times, and check whether your tetanus vaccination is due.

Keep the product container or a photo of the label to hand, and note the time of contact and how long you rinsed: with those details the conversation becomes far more specific.

This material is for information only and does not replace medical advice.