What is the treatment for chemical burns to the hands with symptoms of redness, blistering, and pain?

Management of Chemical Burns to the Hands

For chemical burns to the hands with symptoms of redness, blistering, and pain, immediate irrigation with copious amounts of water is the primary treatment to remove the chemical and prevent further tissue damage. 1

Initial Management

• Brush powdered chemicals off the skin with a gloved hand or piece of cloth before irrigation 1
• Remove all contaminated clothing from the victim, ensuring you don't contaminate yourself in the process 1
• Immediately irrigate the affected area with copious amounts of clean water (Class I, LOE B) 1
• Continue irrigation for at least until pain is relieved, with some evidence suggesting benefits from longer irrigation periods 2
• Do not apply anything by mouth for any poisoning unless advised by poison control center or emergency medical personnel (Class III, LOE C) 1

Wound Care After Irrigation

• After thorough irrigation, loosely cover the burn with a clean cloth or nonadherent dry dressing 1
• For small partial-thickness burns being managed at home, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera after cooling 1
• Apply a clean occlusive dressing to help wounds heal better with less infection 1
• Leave blisters intact as this improves healing and reduces pain (Class IIa, LOE B) 1

Pain Management

• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain relief 1
• Cooling the burn site can help reduce pain by affecting the inflammatory cascade 3
• Multiple inflammatory mediators are released at the site of injury, including monoamines, cytokines, and prostanoids, which activate pain signals 3

When to Seek Medical Attention

• Activate emergency medical services immediately if the patient exhibits any signs of a life-threatening condition (e.g., sleepiness, seizures, difficulty breathing, vomiting) 1
• Burns involving the face, hands, feet, and genitals may require surgical intervention to prevent permanent disability 1
• Burns with large surface area can lead to significant fluid loss and multisystem organ failure 1
• Contact the Poison Help hotline (800-222-1222) for information about treating exposure to a potential poison 1

Evidence on Effectiveness of First Aid

• Early application of water irrigation is associated with reduced hospital stay and less full-thickness injury compared to delayed irrigation 4, 2
• A retrospective study found that patients receiving appropriate first aid showed significantly less full-thickness injury and more than twofold shorter hospital stay 4
• Continuous water irrigation was found to be better than wet packs in achieving earlier recovery 5

Important Considerations

• Do not apply ice directly to a burn as it can produce tissue ischemia (Class III, LOE B) 1
• Remove jewelry before the onset of swelling to prevent constriction and vascular ischemia 1
• Monitor children for signs of hypothermia during cooling of burns 1
• For chemical burns specifically, water irrigation remains the most preferred method of decontamination in acute management 5

Follow-up Care

• After initial first aid, wounds heal better with less infection if covered with an antibiotic ointment or cream and a clean occlusive dressing 1
• Continue to monitor the burn for signs of infection, including increased pain, redness, swelling, or discharge 1
• Seek medical attention if the burn appears to be worsening or shows signs of infection 1