What is the treatment for skin burns caused by excessive soap use?

Treatment for Skin Burns Secondary to Excessive Soap Use

Immediately discontinue soap use, gently cleanse the affected area with lukewarm water or saline, apply a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin or petrolatum-based ointment, and cover with a non-adherent dressing if needed. 1

Understanding the Injury

Excessive soap use causes irritant contact dermatitis, not a true thermal burn, though the skin damage can be similar. 2 Detergents damage the skin by:

• Denaturing stratum corneum proteins 2
• Depleting or reorganizing intercellular lipids 2
• Decreasing corneocyte cohesion 2
• Reducing the skin's water-binding capacity 2

Affected individuals typically experience dryness, burning sensation, rough-feeling skin, erythema, scaling, or fissures. 2

Immediate Management Steps

1. Stop the Offending Agent

• Immediately cease all soap use on the affected area 2
• Avoid hot water for washing, as this worsens skin damage 2

2. Gentle Cleansing

• Irrigate the affected area with lukewarm (not hot) tap water or isotonic saline 1, 3
• If cleansing is necessary, use minimal amounts of mild soap only 2
• Avoid excessive scrubbing or friction 2

3. Restore Moisture Barrier

• Apply a greasy emollient liberally at least once daily to the entire affected area 2, 1
• Preferred options include:
  • 50% white soft paraffin with 50% liquid paraffin 2
  • Petrolatum or petrolatum-based ointments 1
  • Oil-in-water creams (avoid alcohol-containing lotions or gels) 2

4. Address Inflammation

For mild to moderate erythema and irritation:

• Apply topical hydrocortisone 0.5-1% cream 3-4 times daily to affected areas 4
• For more significant inflammation with desquamation, use a mid-potency topical steroid such as prednicarbate cream 0.02% 2
• Apply steroids for short-term use only (typically 1-2 weeks) 2

5. Manage Pruritus

If itching is present:

• Use urea- or polidocanol-containing lotions 2
• Consider oral H1-antihistamines (cetirizine, loratadine, or fexofenadine) for moderate to severe itching 2

6. Treat Fissures (if present)

For cracked or fissured skin:

• Apply propylene glycol 50% in water for 30 minutes under plastic occlusion nightly, followed by hydrocolloid dressing 2
• Alternatively, use antiseptic baths with potassium permanganate (1:10,000 concentration) 2
• Apply emollients liberally around fissured areas 2

Critical Pitfalls to Avoid

• Do not use hot water for washing, as this exacerbates skin damage 2
• Avoid alcohol-based products on damaged skin, as they cause further irritation 2
• Do not apply topical antibiotics unless there are clear signs of secondary infection (increasing pain, purulent discharge, spreading erythema) 1
• Avoid petroleum-based hand lotions if latex gloves will be worn, as petroleum degrades latex 2

Ongoing Care

• Apply emollients at least once daily, preferably multiple times 2
• Use barrier protection (gloves) if hands must be exposed to water or irritants 2
• Monitor for signs of infection: increasing pain, warmth, swelling, or purulent drainage 1
• Consider switching to gentler cleansing products when healing allows 2

When to Seek Further Medical Attention

Consult a dermatologist if:

• Symptoms worsen despite 2 weeks of appropriate treatment 2
• Signs of secondary infection develop 1
• Extensive skin involvement (>10% body surface area) 1
• Severe symptoms including significant pain or functional impairment 2