Home Print this page Email this page Users Online: 267
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 21  |  Issue : 1  |  Page : 76-78

Role of early dermabrasion in sulfuric acid burns


Consultant Plastic Surgeon, Karmakar Hospital, Nashik, Maharashtra, India

Date of Web Publication22-Nov-2013

Correspondence Address:
Sudhir Shriram Karmakar
Karmakar Hospital, Rohini Ravi Apartment, Canada Corner, Sharanpur Road, Nashik - 422 002, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-653X.121890

Rights and Permissions
  Abstract 

Author reports a case of disfigurement of the face, due to concentrated sulfuric acid burns, treated with early dermabrasion and collagen dressing which achieved quick esthetic restoration, mental satisfaction, and early rehabilitation without any complications. Concentrated sulfuric acid usually causes deep burns and scarring, but in this case the interplay of the injuring agent, host, environment, and the immediate and appropriate first aid, helped to limit the resultant burn depth to superficial dermis. Author attributes success in this case to favorable burn depth, quick and appropriate first aid, host and environmental factors, and early diagnosis and appropriate treatment in the form of early dermabrasion.

Keywords: Collagen dressing, early facial dermabrasion, sulfuric acid chemical burns


How to cite this article:
Karmakar SS. Role of early dermabrasion in sulfuric acid burns. Indian J Burns 2013;21:76-8

How to cite this URL:
Karmakar SS. Role of early dermabrasion in sulfuric acid burns. Indian J Burns [serial online] 2013 [cited 2019 Aug 24];21:76-8. Available from: http://www.ijburns.com/text.asp?2013/21/1/76/121890


  Introduction Top


Sulfuric acid usually causes deep burns and scarring. Author reports an unusual case of concentrated sulfuric acid superficial burn leading to facial disfigurement, which received immediate and appropriate first aid on the spot and was subsequently treated with early dermabrasion and collagen dressing.


  Case Report Top


An old tube in an industrial establishment, carrying concentrated sulfuric acid under pressure was punctured accidentally spilling its contents on the face of a 45-year-old male worker. He received urgent and appropriate first aid on the spot within a few minutes of the accident. The face was washed repeatedly with plenty of cold water and topical Neosporin ointment applied. He was administered oral antibiotics and anti-inflammatory agents and was referred to our burn hospital, where he was advised injectable antibiotics and oral anti-inflammatory drugs. Repeated face washes and application of Neosporin ointment were continued daily. The burns resulted in well-demarcated multiple black brown and at places depressed hyper pigmented spots by 5 th day [Figure 1]. As a test, using the late Dr R. J. Maneksha's [1] hand-held dermabrador [Figure 2], dermabrasion of a single spot was carried out to confirm the depth of the lesion. On confirmation that the depth of the lesions was superficial, dermabrasion of other spots was completed under general anesthesia. This procedure removed the pigmented eschar. Appearance of punctate bleeding was the end point. Wounds were dressed with collagen sheets [Figure 3]. Postoperatively, routine antibiotics, anti-inflammatory drugs, and vitamins were given till the collagen peeled off on the 7 th postoperative day. Wounds healed with a satisfactory esthetic facial appearance [Figure 4]. The patient was instructed to apply sunscreen lotion, avoid exposure to sunlight for 6 months, and to return for follow-up monthly. The patient resumed his duties on the 20 th post burn day. Postoperatively, he had no scar or pigmentation problems. A 3-year follow-up revealed good esthetic appearance [Figure 5].
Figure 1: Appearance on 5th day sulfuric acid burn

Click here to view
Figure 2: Dr. R. J. Maneksha's dermabrador

Click here to view
Figure 3: With collagen dressing

Click here to view
Figure 4: Acid burn 7th day postdermabrasion

Click here to view
Figure 5: Sulfuric acid burn long-term follow-up

Click here to view



  Discussion Top


Burns of the torso can be hidden with some effort but facial-burn scars are obvious at first sight. Being the symbol of self-esteem, beauty and identity, the smallest disfigurement of face causes a disproportionate physical and psychological impact.
"Sulfuric acid face burns" reminds one of terribly disfigured faces due to vitriolage, but it can occur accidently at work and home. [2] Sulfuric acid reacts with glucose in the tissues to release carbon, [3] producing a brownish black eschar. At high concentration, sulfuric acid burns are more deleterious than thermal burns, [4] because this acid not only causes chemical burns via hydrolysis, but also secondary thermal burns via dehydration. The protein destruction due to hydrolysis may continue for long as the traces of the acid are present in the tissues before it is thoroughly washed off [5] with water or neutralized with a neutralizing agent. Water cannot eliminate the chemical product from the deeper layers of the burn wound, but it must be used immediately to dilute the chemical and wash away as much as possible to prevent the penetration in deeper tissues. Time is a critical factor and prompt decontamination is the key to mitigate complications. [4]

Hence, the main emphasis in sulfuric acid burns is on its prompt, appropriate first aid and prevention.

Author feels that irrespective of the hazardous nature of injuring agent, it is the resultant burn depth, which decides the clinical appearance and the choice of appropriate treatment. This resultant burn depth, besides depending on the injuring agent, is also subject to or determined by the host and the environment. In this case, the injuring agent was 70% concentrated sulfuric acid under pressure, which is known to cause deep burns. However, clinical appearance pointed that resultant depth of burn got restricted to superficial dermis due to the following factors:

  1. Ultra short (few seconds) duration of contact of the injuring agent (concentrated sulfuric acid under pressure),
  2. Narrow spray or sprinkle-like mode of contact delivering the least quantity of injuring agent at one point on the surface of the skin, and
  3. Immediate and appropriate first aid.


The author selected dermabrasion because careful removal of all damaged cells can be performed more precisely with it than with the more conventional Weck knife or dermatome excision. The intact structures are not damaged and a more reliable assessment of the burn's healing potential and actual depth can be achieved early in the process. [6] Versa-jet-modality being expensive; the author selected Maneksha's dermabrador in this case for its affordability, precision, and safety.

Early dermabrasion achieves escharectomy, removal of pigment, and derma-planning of depressed spots in one sitting. As there were no further complications, it avoided further secondary treatments. Thus, it acted as a definitive primary treatment modality with excellent esthetic restoration.

It has proved to be useful when the chemical is sprinkled in droplets. It remains to be seen if it will work and give same results in more extensive burns.

Collagen was used, because it promotes early primary wound healing of dermabraded wounds. Only one dressing was sufficient to achieve wound healing within 7 days.

Use of dermabrasion is reported in superficial pigmented lesions, scars, and tattoos, [7],[8] but use of early dermabrasion for treatment of the eschar of concentrated sulfuric acid superficial burns and the use of collagen to dress such dermabraded wounds is unreported in current literature.[9]


  Conclusion Top


Early and correct diagnosis of burn depth and early execution of the most appropriate treatment modality are the crucial factors for success. One should encourage early and appropriate first aid which helps to keep the burn depth to a minimum.

In sulfuric acid burns, innovative early use of dermabrasion as definitive primary treatment modality is safe, successful, and achieves quick esthetic facial appearance, mental satisfaction, and the early physical rehabilitation, provided the depth of burn is limited to the superficial dermis as seen in this case.

This method could be a useful tool in the armamentarium of the plastic surgeon for the management of such superficial acid burns.

 
  References Top

1.Khadalia KJ. R. J. Maneksha-The human face of Indian Plastic Surgery. Indian J Plast Surg 2011;44:377-9.  Back to cited text no. 1
    
2.Palao R, Mongue I, Ruiz M, Barret JP. Chemical burns: Pathophysiology and treatment. Burns 2010;36:295-304.  Back to cited text no. 2
    
3.Sarabahi S, Tiwari VK. Clinical atlas of burn management. 1st ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2011. p. 167.  Back to cited text no. 3
    
4.Sethi G, Reddy BV, Maibach HI. Sulfuric acid burns. Kanerva's Occupational Dermatology 2012:1951-4.  Back to cited text no. 4
    
5.Wikipedia [Internet]. Sulfuric acid-Wikipedia, the free encyclopedia, Available from: http://www.en.wikipedia.org/wiki/Sulfuric acid. [Last accessed on 2013 Aug 23].  Back to cited text no. 5
    
6.Sinilo ML. Chemical burns and their treatment. Acta Chir Plast 1961;3:311-7.  Back to cited text no. 6
    
7.Sawant SS. Facial dermabrasion in acne scars and genodermatoses-A study of 65 patients. Indian J Dermatol Venerol Leprol 2000;66:79-84.  Back to cited text no. 7
    
8.Boo-Chai K. The decorative tattoo: Its removal by dermabrasion. Plast Reconstr Surg 1963;32:559-63.  Back to cited text no. 8
    
9.Clabaugh W. Removal of tattoos by superficial dermabrasion. Arch Dermatol 1968;98:515-21.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed2764    
    Printed57    
    Emailed0    
    PDF Downloaded95    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]