What is the treatment for acid burns?

Treatment for Acid Burns

Immediately irrigate acid burns with copious amounts of water for at least 15-20 minutes—this is the single most critical intervention that directly determines outcomes. 1

Immediate First Aid Management

Step 1: Remove and Irrigate

• Brush off any dry powdered acid before applying water to prevent exothermic reactions 2
• Remove all contaminated clothing immediately to prevent the chemical from being trapped against skin and causing continued injury 2
• Begin water irrigation immediately with copious amounts of clean running water for at least 15-20 minutes—every minute of delay worsens tissue damage 1, 3
• Continue irrigation until the affected area returns to physiologic pH 4

Step 2: Initial Cooling (After Irrigation)

• Cool the burn with clean running water (15-25°C) for 5-20 minutes if the burn area is small (<20% total body surface area in adults) to limit burn depth and reduce pain 2
• Do not cool if the patient shows signs of shock or if the burn covers >20% TBSA in adults or >10% in children, as this increases hypothermia risk 2
• Remove jewelry from the affected area before swelling occurs 5

Wound Care After Decontamination

Cleaning and Dressing

• Clean the wound with tap water, isotonic saline, or antiseptic solution in a clean environment after proper pain control is established 2
• Apply a thin layer of petrolatum-based ointment or antibiotic ointment (such as bacitracin or polymyxin B) with a clean non-adherent dressing 5, 2
• Cover with a clean, non-adherent dressing changed once to twice daily 5, 6

What NOT to Do

• Do not apply ice directly to burns—this causes additional tissue damage 2
• Do not use butter, oil, or break blisters—these increase infection risk and worsen outcomes 2
• Do not use topical antibiotics as first-line treatment—reserve for infected wounds to prevent antimicrobial resistance 2

Pain Management

Systemic Analgesia

• Administer over-the-counter oral analgesics such as acetaminophen or NSAIDs for mild to moderate pain 5
• Consider multimodal analgesia with both acetaminophen and NSAIDs if pain is significant 5
• Use short-acting opioids and titrated intravenous ketamine for severe pain—ketamine is particularly effective for burn-induced pain and reduces morphine requirements 2

When to Seek Emergency Care

Immediate referral to a burn center or emergency department is required if: 2

• Burns involve the face, hands, feet, or genitals
• Burns cover >10% TBSA in adults or >5% in children
• Any full-thickness (third-degree) burns are present
• Signs of respiratory involvement (difficulty breathing, soot around nose/mouth)
• Signs of infection (increasing pain, redness, swelling, purulent discharge)
• Severe pain unresponsive to first-line treatments 5

Special Considerations

Hydrofluoric Acid Burns

• Hydrofluoric acid requires special management beyond standard water irrigation, as it acts as both an acid and alkali in tissues 7, 8
• Specific antidotes may be required for hydrofluoric acid exposure 8

Critical Pitfall

The most common and dangerous error is delaying irrigation—every minute counts in removing acid from tissue, and outcomes are directly dependent on how quickly decontamination begins 2, 3