Management of Chemical Burns to the Scalp
Immediately irrigate the scalp with copious running water for at least 15 minutes, starting as soon as possible after exposure, and remove any contaminated materials from the area. 1
Immediate First Aid (Priority Actions)
Decontamination
- Begin irrigation with running water immediately – this is the single most critical intervention for chemical burns to the scalp 1
- Continue irrigation for at least 15 minutes with running water (15-25°C) 1, 2
- If dry chemical powder is visible, brush it off before water irrigation to prevent activation of certain chemicals 1
- Remove all contaminated clothing, jewelry, hair accessories, and surrounding materials from the scalp area to prevent continued exposure 1
Safety Precautions
- Wear personal protective equipment before providing care to avoid contaminating yourself with the caustic agent 1
- Ensure the irrigation runoff does not contaminate other body areas or individuals 1
Pain Management
Immediate Pain Control
- Cool water irrigation itself provides significant pain relief and should precede any dressing application 2
- For severe pain, administer titrated intravenous opioids (short-acting agents like fentanyl) combined with ketamine 2, 3
- All analgesics must be titrated using validated pain assessment scales 2, 3
- Acetaminophen or NSAIDs may be sufficient for minor chemical burns 4
Wound Care After Irrigation
Cleaning and Assessment
- After thorough irrigation, clean the wound with tap water, isotonic saline, or antiseptic solution in a clean environment 2
- Assessment of burn depth is often difficult with chemical burns and may evolve over time as tissue necrosis can continue despite cessation of exposure 5, 6
Dressing Application
- Apply petrolatum-based antibiotic ointment or petrolatum alone with a clean nonadherent dressing 2
- Alternatively, medical-grade honey or aloe vera can be used 2
- Avoid prolonged use of silver sulfadiazine on superficial burns as it may delay healing 2
- Moist dressings significantly reduce complications including hypertrophic scarring compared to dry dressings 2
When to Activate Emergency Medical Services
Call EMS immediately if the patient has: 1
- Respiratory symptoms (suggesting inhalation injury)
- Systemic symptoms
- Large chemical exposures
- Burns involving the face, scalp with significant surface area, hands, feet, or genitals 2
Specialized Consultation
Contact Poison Control
- Consult your regional poison center for chemical-specific decontamination procedures and duration of irrigation recommendations 1
- Different chemicals may require specialized treatment beyond standard water irrigation 1, 7
Burn Center Referral Criteria
- Burns covering >10% total body surface area (TBSA) in adults or >5% in children 2
- All full-thickness burns 2
- Burns to the face/scalp with significant involvement 2
- Signs of infection (increasing pain, redness, swelling, purulent discharge) 2
- Any signs of inhalation injury 2
Critical Pitfalls to Avoid
- Do not delay irrigation – immediate decontamination within 10 minutes with large volume irrigation for at least 15 minutes decreases full-thickness burns, number of burns, and hospital length of stay 1
- Do not apply ice directly to the burn as this causes tissue ischemia 2
- Do not use topical antibiotics prophylactically – reserve them only for infected wounds to prevent antimicrobial resistance 2
- Do not underestimate the injury – chemical burns can continue to cause tissue damage after initial exposure, and depth assessment is difficult early on 5, 6
- Do not neutralize acids with alkali or vice versa – this generates heat and worsens tissue injury; water irrigation is the standard approach 1, 7