What is the treatment for chemical burns to the dorsal surface of the feet, presenting with swelling and pain 3 days post-exposure?

From the Guidelines

Seek immediate medical attention for concrete burns on your feet that are now swollen and painful after 3 days. Concrete burns are chemical burns caused by the alkaline nature of wet concrete (pH 12-13) and can continue to damage tissue even after exposure ends. While waiting for medical care, gently rinse the area with cool water for 20 minutes to remove any remaining concrete particles, then cover with a clean, dry bandage, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Do not apply home remedies, ointments, or break any blisters. Take acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400mg every 6 hours with food for pain if you have no contraindications to these medications. Elevate your feet above heart level to reduce swelling, as elevation of the injured body part, especially if swollen, accelerates healing 1. The increasing pain and swelling after 3 days suggests the burns may be deeper than initially apparent or possibly infected, which requires professional evaluation. Concrete burns often appear minor at first but can progress to serious third-degree burns that may require specialized wound care, antibiotics, or even surgical debridement.

Some key considerations for the management of concrete burns include:

• Gently rinsing the area with cool water to remove any remaining concrete particles
• Covering the area with a clean, dry bandage
• Elevating the affected area to reduce swelling
• Avoiding the application of home remedies, ointments, or breaking any blisters
• Taking pain medication as directed if there are no contraindications
• Seeking immediate medical attention for professional evaluation and treatment, as burn wound infections can be polymicrobial and require accurate management of the wound with early excision of the eschar to substantially decrease the incidence of invasive burn wound infection 1.

It is also important to note that burn wound care should be performed in a clean environment and may require deep analgesia or general anesthesia, and the type of dressing depends on the total body surface area (TBSA) affected, the local appearance of the wound, and the patient’s general condition 1.

From the FDA Drug Label

Prompt institution of appropriate regimens for care of the burned patient is of prime importance and includes the control of shock and pain. The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions.

The patient with concrete burns to the dorsal feet should have their burn wounds cleansed and debrided, and then silver sulfadiazine cream, USP 1% should be applied under sterile conditions. The cream should be applied once to twice daily to a thickness of approximately one sixteenth of an inch. Pain control is also an important part of the treatment regimen. Treatment with silver sulfadiazine cream, USP 1% should be continued until satisfactory healing has occurred or until the burn site is ready for grafting 2.

From the Research

Burn Care and Treatment

• The treatment of burns, including those to the dorsal feet, requires careful consideration of the burn depth and percentage of total body surface area involved 3.
• Initial treatment is directed at stopping the burn process, and superficial (first-degree) burns can be treated with simple first-aid techniques and over-the-counter pain relievers 3.
• Partial-thickness (second-degree) burns, which may take up to three weeks to heal, require advanced dressings to protect the wound and promote a moist environment 3.

Topical Treatment Options

• Silver sulfadiazine is an effective topical antibacterial agent with low toxicity and few side effects, and can be used to treat burns 4, 5.
• Other topical treatment options include silver nitrate, mafenide acetate, and povidone-iodine complex 5.
• The choice of topical treatment will depend on the specific needs of the patient and the severity of the burn.

Management of Burns to the Feet

• The care of burns to the foot can be complex or straightforward, depending on the nature of the burn, and requires experience and training 6.
• Understanding the pathophysiology of burns, appropriate acute management, and initial reconstruction guided by the long-term needs of the patient are key to good management of burns to the feet 6.

Infection Prevention and Treatment

• Prophylactic antibiotics are not indicated for outpatient management of burns and may increase bacterial resistance 3.
• Silver sulfadiazine has been shown to be effective in reducing the clinical infection rate and culture rate of Pseudomonas and Staphylococcus in burn patients 7.
• Other topical treatments, such as mafenide, may also be effective in preventing and treating infections in burn patients 7.