What is the workup and treatment for a patient with chemical burns to the scalp and face following a permanent wave (perm) treatment, currently without signs of infection?

From the Guidelines

For a patient with chemical burns to the scalp and face following a perm treatment, I strongly recommend immediate gentle cleansing of the affected areas with cool water to remove any remaining chemicals, followed by application of a nonadherent bandage or clean cloth to protect the wound and reduce pain, as suggested by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.

Initial Management

The patient should have the affected areas cleaned with cool water to remove any remaining chemicals from the perm solution. This is crucial in preventing further damage to the skin.

• Apply petroleum jelly (Vaseline) or a bland emollient like Aquaphor to the burned areas 3-4 times daily to maintain moisture and protect the skin.
• For pain management, recommend acetaminophen 650mg every 6 hours or ibuprofen 400mg every 6 hours as needed.

Wound Care

• If the burn appears superficial, a topical antibiotic ointment like bacitracin can be applied twice daily to prevent infection, although antibiotic prophylaxis should not be administered routinely 1.
• The patient should avoid harsh soaps, hair products, and heat styling until healing occurs.

Inflammation and Follow-Up

• For moderate discomfort, a low-potency topical steroid like hydrocortisone 1% cream can be applied twice daily for up to 7 days to reduce inflammation.
• The patient should return for follow-up if they develop increasing pain, redness, swelling, drainage, fever, or if symptoms don't improve within 3-5 days, as these could indicate infection or deeper tissue damage requiring more aggressive treatment.

Burn Wound Dressings

• Burn wound dressings can reduce pain, protect the wound from external contamination, and limit heat loss, but should be applied after a well-conducted resuscitation and ideally under the guidance of a burns specialist 1.
• The type of dressing depends on the extent of the burn, the local appearance of the wound, and the patient’s general condition.
• Ideally, dressings should be re-evaluated daily to prevent the bandages from inducing a tourniquet effect and to monitor distal perfusion.

From the Research

Workup for Chemical Burns to the Scalp and Face

• The initial workup for chemical burns to the scalp and face following a permanent wave (perm) treatment involves assessing the extent and depth of the burn injury 2.
• The burn depth is usually categorized into first-degree (superficial, involving only the epidermis), second-degree (partial thickness, involving both epidermis and dermis), and third-degree (full thickness, through the epidermis, dermis, and into fat) 2.

Treatment for Chemical Burns to the Scalp and Face

• Topical antimicrobial agents have been shown to decrease wound-related infections and morbidity in burn wounds when used appropriately 3, 4, 2.
• The goal of topical antimicrobial therapy is to control microbial colonization, thus preventing development of invasive infections 3, 2.
• Topical antimicrobials of choice include bacitracin, neomycin, polymyxin B, mupirocin, nitrofurazone, fusidic acid, silver sulfadiazine, and mafenide 3, 4, 2, 5.
• Compounded preparations of 1:1:1 + Double Antibiotic and 3:1 + Double Antibiotic were found to be effective against 100% of the isolates tested in one study 4.

Prevention of Infection

• Topical antibiotics probably reduce the risk of surgical site infection (SSI) in people with surgical wounds healing by primary intention compared with no topical antibiotic or topical antiseptics 6.
• The use of topical antimicrobial agents can help prevent infection and promote healing in chemical burns to the scalp and face 3, 4, 6, 2, 5.