|Year : 2013 | Volume
| Issue : 1 | Page : 76-78
Role of early dermabrasion in sulfuric acid burns
Sudhir Shriram Karmakar
Consultant Plastic Surgeon, Karmakar Hospital, Nashik, Maharashtra, India
|Date of Web Publication||22-Nov-2013|
Sudhir Shriram Karmakar
Karmakar Hospital, Rohini Ravi Apartment, Canada Corner, Sharanpur Road, Nashik - 422 002, Maharashtra
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
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|| |
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  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].
| Discussion|| |
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.  Sulfuric acid reacts with glucose in the tissues to release carbon,  producing a brownish black eschar. At high concentration, sulfuric acid burns are more deleterious than thermal burns,  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  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. 
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:
- Ultra short (few seconds) duration of contact of the injuring agent (concentrated sulfuric acid under pressure),
- 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
- 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.  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, , 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.
| Conclusion|| |
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.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]