Chemical Burns

Chemical burns represent a small percentage of burn injuries yet up to one third of burn-related deaths. A substantial number of common household and industrial cleaners are responsible for the chemical burns encountered. The pathophysiology of chemical burns, not unlike thermal injuries, is the denaturing of structural proteins, depending on the mechanism of action, concentration, manner and duration of contact, and quantity and phase of agent. Six mechanisms of action are responsible for destruction: reduction, oxidation, corrosion, vesication, desiccation, and protoplasmic poison. Underlying these mechanisms of action are two main categories: acids and alkali compounds. Key to management of chemical injuries is to stop the burning process with copious irrigation, and barring specific treatments outlined in the chapter, the typical burn management of topical agents versus grafting depending on the depth of the injury. Neutralizing agents are contraindicated and can lead to further injury secondary to exothermic reactions.