Which specialist should evaluate a one‑week‑old chemical burn of the scalp?

Burn Specialist Referral for Chemical Scalp Burns

A one-week-old chemical burn of the scalp requires immediate evaluation by a burn specialist or burn center, regardless of size, because chemical burns—particularly those involving function-sensitive areas like the scalp—require expert assessment to determine depth, ongoing tissue damage, and need for specialized surgical intervention. 1, 2

Why Immediate Burn Specialist Consultation is Critical

Chemical burns present unique assessment challenges that mandate specialist evaluation:

• Chemical burns continue to cause progressive tissue necrosis even after initial exposure has ceased, making depth assessment extremely difficult for non-specialists 2, 3
• The scalp is considered a function-sensitive anatomical area (similar to face, hands, feet, and perineum) that automatically requires burn specialist consultation according to burn center referral criteria 4, 1
• Chemical burns of any type are explicit criteria for burn center referral in both adults and children 4, 1

The One-Week Delay Increases Urgency

The one-week timeline since injury makes specialist evaluation even more critical:

• Delayed specialist referral for chemical burns increases morbidity and mortality through undertriage 4, 5
• Chemical burn depth evolves over days to weeks, and what appeared superficial initially may have progressed to deep partial-thickness or full-thickness injury requiring surgical excision 2, 3
• Early surgical excision and skin grafting at burn centers significantly reduce morbidity, mortality, and hospital length of stay for deep burns 4, 5

How to Arrange Specialist Consultation

Use telemedicine if immediate in-person specialist access is unavailable:

• Telemedicine consultation with burn specialists reliably improves burn severity assessment and prevents both overtriage and dangerous undertriage 4, 1
• Telemedicine systems should allow rapid image transfer to enable specialist assessment of burn depth and extent 4

Arrange direct admission to a burn center rather than sequential transfers if hospitalization is needed:

• Direct burn center admission improves survival and functional outcomes compared to transfers through multiple facilities 4, 1, 5
• Burn centers provide concentrated expertise in chemical burn management and specialized surgical techniques not available at general hospitals 4, 5

Common Pitfalls to Avoid

Do not delay referral based on perceived burn size or superficial appearance:

• Chemical burns can appear deceptively superficial initially but progress to full-thickness injury over days 2, 3
• Scalp location alone mandates specialist evaluation regardless of total body surface area involved 4, 1

Do not attempt definitive wound management without specialist guidance:

• Chemical burns may require specific neutralization strategies or specialized wound care depending on the causative agent 2, 3
• Depth assessment requires expert evaluation to determine if early tangential excision is needed 6, 2