What is the treatment for a chemical burn?

Treatment for Chemical Burns

Chemical burns should be immediately irrigated with copious amounts of clean running water for at least 15-20 minutes to minimize tissue damage and reduce the risk of long-term complications. 1, 2

Immediate Management of Chemical Burns

Initial Response

1. Remove the person from the source of exposure
2. Remove contaminated clothing and jewelry to prevent trapping chemicals against skin 2
3. For dry chemicals, brush off as much powder as possible before irrigation 2
4. Begin immediate irrigation:
   • Use clean running water (preferred due to immediate availability) 1, 2
   • Continue irrigation for 15-30 minutes 1, 2
   • For eye exposures, keep eyelids open during irrigation and direct water flow from inner corner outward 2

Irrigation Technique

• Use copious amounts of water to dilute and remove the chemical 1
• Ensure the entire affected area is thoroughly irrigated 1
• For children, monitor for signs of hypothermia during cooling 1

Post-Irrigation Management

Wound Care

• After cooling, cover small partial-thickness burns with:
  • Petrolatum or petrolatum-based antibiotic ointment
  • Honey or aloe vera
  • Clean nonadherent dressing 1
• For burns awaiting professional evaluation, loosely cover with clean cloth or nonadherent dry dressing 1
• For larger burns, silver sulfadiazine cream 1% may be applied to a thickness of approximately 1/16 inch once to twice daily (for burns requiring medical attention) 3

Pain Management

• Administer over-the-counter pain medications such as acetaminophen or NSAIDs 1

When to Seek Medical Attention

Immediate medical attention is required for:

• Burns involving the face, hands, feet, or genitals
• Burns covering >10% body surface area (>5% in children)
• Signs of inhalation injury (facial burns, difficulty breathing, singed nasal hairs, soot around nose/mouth)
• Full-thickness burns
• Chemical eye injuries (after initial irrigation) 1, 2

Special Considerations

Chemical Eye Burns

• Immediate irrigation with water for at least 15 minutes is critical 2
• Seek immediate ophthalmologic evaluation after initial irrigation 2
• Normal saline or commercial eye wash solutions can be used if immediately available 2
• Do not apply eye patches or bandages before medical evaluation 2

Specific Chemicals

• For certain chemicals like hydrofluoric acid and phenol, specific antidotes may be required - contact poison control (800-222-1222 in US) for guidance 2

Common Pitfalls to Avoid

• Delaying irrigation - this is the most critical step in chemical burn management 1, 2
• Stopping irrigation too early - continue for at least 15 minutes 2
• Using pressure or rubbing the affected area - this can cause further damage 2
• Applying home remedies before proper decontamination
• Failing to remove contaminated clothing or jewelry 2

Recent research confirms that continuous water irrigation remains the most preferred method of decontamination in acute chemical burn management, outperforming other approaches like wet packs or immediate surgical debridement 4.