A Rare Case of a Second-Degree Chemical Burn due to Successive Contacts of Acidic Wart Removal Solution and Paint Solution
Authors:   Faculty Medicine of Christian Krida Wacana University, Indonesia, Gressida Lysia Matius , Amri Myra Sylvina ,   General Surgery, Mayapada Hospital, Indonesia, Fawzy Ahmad ,   Department of Surgery, University of Jenderal Soedirman – Margono Soekarjo County Hospital, Indonesia, Putranti Ismiralda Oke ,   Department of Dermatovereology, University of Jenderal Soedirman – Wijayakusuma Army Hospital, Indonesia
Published: April 2023

Introduction: Chemical burns are an uncommon form of burn injury, accounting for 2.1% to 6.5% of all burn centre admissions. We presented one rare case of a second degree chemical burn due to successive contacts of acidic wart removal solution and paint mixture solution. Case: A 38-year-old male with chemical burn on both feet due to reckless usage of a self-purchased wart removal solution, and accidental contact with paint mixture solution. Our surgeon author diagnosed a superficial partial thickness (second-degree) chemical burn on this patient, and performed surgical debridement followed by hyaluronic-enhanced silver sulfadiazine topical dressing to provide antimicrobial protection to the wound and topical petrolatum-based ointment to maintain moist environment for the wound and the periwound. Our team also gave Ceftaroline, a cephalosporin for serious infections of the skin and tissues below the skin, intravenously. Result: One day after the surgical procedure, the wound dimensions were slightly more extensive than the initial size due to extensive debridement and necrotomy. All wounds produced no or minimal exudate, showed no slough nor pus inside the granulation area, and no swelling nor maceration in the periwound area. The fifth day after the surgical procedure, the wound on the lateral side of patient’s right foot was almost completely covered by epithelialization. The wound on the sole of patient’s right foot was about 70-80% covered by epithelialization, and the wound on the sole of patient’s left foot was also about 70% covered by epithelialization. Discussion: Topical solution for wart removal consists of many chemicals agents (i.e. salicylic acid and acetic acid) and its application should strongly be under guidance and monitoring by physician due to its potential to harm human bodies and trigger chemical burn injury in varying degrees. Paint mixture is usually safe, risks no or minimal harms when in contact with skin, however it can provide a more difficult scenario and consequently a more extensive cleansing during the wound debridement procedure. Immediate decontamination and adequate dilution through massive irrigation is a major determinant of burn severity after chemical injury. Application of 1% silver sulfadiazine topical antibiotics enhanced with 0.2% hyaluronic acid for moisturizer displayed significant improvement for the burn wound healing. Conclusion: Knowing exactly what type of chemical substance in contact with the skin and tissues that caused the chemical burn injury is as equally important as the comprehensive management itself. For acidic burn injuries, a proper and sometimes extensive necrotomy procedure is mandatory to provide a good tissue regeneration.