Treatment of Superficial Acidic Chemical Burn to the Penis
This patient requires immediate referral to a burn specialist or emergency department for evaluation, as genital burns—even superficial ones—require specialized assessment and may need surgical intervention to prevent permanent functional disability. 1, 2
Immediate First Aid (If Not Already Done)
Since the exposure occurred last week, the critical window for decontamination has passed, but for future reference:
- Immediate irrigation with copious running water for at least 15 minutes is the cornerstone of chemical burn first aid and should have been performed immediately after exposure 1
- Remove all contaminated clothing and jewelry from the affected area to prevent continued chemical contact 1
- Patients who received immediate irrigation within 10 minutes with large volumes of water for at least 15 minutes have significantly decreased full-thickness burns and shorter hospital stays 1
Why This Patient Needs Specialist Evaluation
Burns involving the genitals may require surgical intervention to prevent permanent disability, regardless of initial appearance. 1, 2 The 2024 American Heart Association and American Red Cross guidelines explicitly state that partial-thickness burns involving the genitalia require hospital treatment 1, and the American Burn Association recommends that genital burns be treated in specialized burn centers 1.
Key Clinical Concerns:
- Chemical burns can progress over time: What appears as mild erythema initially may evolve into deeper injury over 24-72 hours, as chemical agents continue tissue penetration even after surface decontamination 3, 4
- Genital tissue is highly specialized: Even superficial burns can lead to scarring, contractures, and functional impairment if not properly managed 5, 6
- Assessment of true burn depth is difficult early on: The demarcation zone may not be clear for several days 5, 6
Current Management Approach
Conservative Initial Treatment (While Arranging Specialist Evaluation):
- Pain control: Administer over-the-counter NSAIDs or acetaminophen for pain management 1
- Wound coverage: Apply petrolatum or petrolatum-based antibiotic ointment with a clean, non-adherent dressing 1, 2
- Monitor for progression: Watch for increasing pain, deepening erythema, blister formation, skin sloughing, or signs of infection 2, 6
What NOT to Do:
- Do not apply ice directly to the burn 2
- Do not apply butter, oil, or other home remedies 2, 7
- Do not assume superficial appearance means benign outcome: Chemical burns behave differently than thermal burns and can deepen over time 3, 4
Specialist Management
Once evaluated by a burn specialist, the typical approach for genital chemical burns includes:
- Conservative management is preferred initially until the demarcation zone becomes clear, as genital tissue has excellent vascularization and healing potential 5, 6
- Preserve viable tissue: Only clearly non-viable tissue should be debrided, as marginal tissue often survives due to excellent collateral blood flow 6
- Skin grafting may be required: In one series, 66.7% of isolated genital chemical burns required split-thickness skin grafting for optimal functional and cosmetic outcomes 5
- Early enzymatic debridement with bromelain-based agents is an emerging technique that allows more selective tissue preservation 6
Critical Pitfall to Avoid
The most dangerous error is assuming that "mild erythema" one week post-exposure means the injury is trivial. Chemical burns to the genitals have unique characteristics: they can appear deceptively superficial initially but progress to deeper injury, and even superficial burns can cause significant functional impairment through scarring and contracture formation 5, 3, 6. The specialized nature of genital tissue and the potential for devastating functional consequences mandate specialist evaluation for all but the most trivial exposures.