The treatment of alkaline burns of the skin by neutralization

Kris Andrews, Arian Mowlavi, Stephen M. Milner

Research output: Contribution to journalArticle

Abstract

Literature reports dating as far back as 1927 have lured clinicians into the belief that alkaline skin burns are best treated by water dilution and that neutralization attempts should be avoided. Although this belief has never been substandated, neutralization of an alkaline bum of the skin with acid was thought to increase tissue damage secondary to the exothermic nature of acid-base reactions. The authors proposed that topical treatment of alkaline burns with a weak acid such as 5% acetic acid (i.e., household vinegar) would result in rapid tissue neutralization and reduction of injury in comparison to water irrigation alone. In a rat skin burn model, animals were exposed to an alkaline injury when filter paper (2 cm in diameter) saturated with 2N sodium hydroxide was placed over the volar aspect of the animal for a period of 1 minute. Treatment was initiated 1 minute after injury and included either neutralization with a 5% acetic acid solution (n = 8) or irrigation (n = 8) with water. Skin temperature and pH were monitored using subdermal needle probes until the pH of the skin returned to physiologic values. Punch-biopsy specimens were obtained from the wound edges 24 hours after injury to assess bum depth and leukocyte infiltration, and biopsies were repeated 10 days later to assess wound healing. The authors proposed that neutralization of an alkaline substance with household vinegar (i.e., 5% acetic acid solution) would result in rapid neutralization and thus reduce extent of tissue injury. Animals treated with acetic acid demonstrated a more rapid return to physiologic pH (14.69 ± 4.06 minutes versus 31.62 ± 2.83 minutes; p <0.001), increased depth of dermal retention (0.412 ± 136 mm versus 0.214 ± 0.044 mm; p = 0.015), decreased leukocyte infiltrate (31.0 ± 5.1 cells/highpower field versus 51.8 ± 6.8 cells/high-power field; p <0.001), and improved epithelial regeneration (4.0 ± 0.6 cell layers versus ± 0.5 cell layers; p <0.001) when compared with animals treated with water irrigation. No difference was detected in peak pH (10.35 ± 0.28 pH versus 10.36 ± 0.25 pH; p = 0.47) nor in rise of skin temperature (maximum temperature, 32.8°C versus 32.9°C; p = 0.33) between acetic acid-neutralized and water-irrigated burn wounds. The observed benefits of treating alkaline burns with 5% acetic acid in the rat model are significant and require clinical testing.

Original languageEnglish (US)
Pages (from-to)1918-1921
Number of pages4
JournalPlastic and Reconstructive Surgery
Volume111
Issue number6
DOIs
StatePublished - May 2003
Externally publishedYes

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Burns
Acetic Acid
Skin
Wounds and Injuries
Water
Skin Temperature
Acids
Leukocytes
Biopsy
Sodium Hydroxide
Wound Healing
Needles
Regeneration
Animal Models
Temperature

ASJC Scopus subject areas

  • Surgery

Cite this

The treatment of alkaline burns of the skin by neutralization. / Andrews, Kris; Mowlavi, Arian; Milner, Stephen M.

In: Plastic and Reconstructive Surgery, Vol. 111, No. 6, 05.2003, p. 1918-1921.

Research output: Contribution to journalArticle

Andrews, Kris ; Mowlavi, Arian ; Milner, Stephen M. / The treatment of alkaline burns of the skin by neutralization. In: Plastic and Reconstructive Surgery. 2003 ; Vol. 111, No. 6. pp. 1918-1921.
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abstract = "Literature reports dating as far back as 1927 have lured clinicians into the belief that alkaline skin burns are best treated by water dilution and that neutralization attempts should be avoided. Although this belief has never been substandated, neutralization of an alkaline bum of the skin with acid was thought to increase tissue damage secondary to the exothermic nature of acid-base reactions. The authors proposed that topical treatment of alkaline burns with a weak acid such as 5{\%} acetic acid (i.e., household vinegar) would result in rapid tissue neutralization and reduction of injury in comparison to water irrigation alone. In a rat skin burn model, animals were exposed to an alkaline injury when filter paper (2 cm in diameter) saturated with 2N sodium hydroxide was placed over the volar aspect of the animal for a period of 1 minute. Treatment was initiated 1 minute after injury and included either neutralization with a 5{\%} acetic acid solution (n = 8) or irrigation (n = 8) with water. Skin temperature and pH were monitored using subdermal needle probes until the pH of the skin returned to physiologic values. Punch-biopsy specimens were obtained from the wound edges 24 hours after injury to assess bum depth and leukocyte infiltration, and biopsies were repeated 10 days later to assess wound healing. The authors proposed that neutralization of an alkaline substance with household vinegar (i.e., 5{\%} acetic acid solution) would result in rapid neutralization and thus reduce extent of tissue injury. Animals treated with acetic acid demonstrated a more rapid return to physiologic pH (14.69 ± 4.06 minutes versus 31.62 ± 2.83 minutes; p <0.001), increased depth of dermal retention (0.412 ± 136 mm versus 0.214 ± 0.044 mm; p = 0.015), decreased leukocyte infiltrate (31.0 ± 5.1 cells/highpower field versus 51.8 ± 6.8 cells/high-power field; p <0.001), and improved epithelial regeneration (4.0 ± 0.6 cell layers versus ± 0.5 cell layers; p <0.001) when compared with animals treated with water irrigation. No difference was detected in peak pH (10.35 ± 0.28 pH versus 10.36 ± 0.25 pH; p = 0.47) nor in rise of skin temperature (maximum temperature, 32.8°C versus 32.9°C; p = 0.33) between acetic acid-neutralized and water-irrigated burn wounds. The observed benefits of treating alkaline burns with 5{\%} acetic acid in the rat model are significant and require clinical testing.",
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