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Sandaruwan HHPB, Manatunga DC, N Liyanage R, Costha NP, Dassanayake RS, Wijesinghe RE, Zhou Y, Liu Y. Next-generation methods for precise pH detection in ocular chemical burns: a review of recent analytical advancements. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2025; 17:408-431. [PMID: 39564777 DOI: 10.1039/d4ay01178c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2024]
Abstract
Ocular burns due to accidental chemical spillage pose an immediate threat, representing over 20% of emergency ocular traumas. Early detection of the ocular pH is imperative in managing ocular chemical burns. Alkaline chemical burns are more detrimental than acidic chemical burns. Current practices utilize litmus, nitrazine strips, bromothymol blue, fluorescent dyes, and micro-combination glass probes to detect ocular pH. However, these methods have inherent drawbacks, leading to inaccurate pH measurements, less sensitivity, photodegradation, limited pH range, and longer response time. Hence, there is a tremendous necessity for developing relatively simple, accurate, precise ocular pH detection methods. The current review aims to provide comprehensive coverage of the conventional practices of ocular pH measurement during accidental chemical burns, highlighting their strengths and weaknesses. Besides, it delves into cutting-edge technologies, including pH-sensing contact lenses, microfluidic contact lenses, fluorescent scleral contact lenses, fiber optic pH technology, and pH-sensitive thin films. The study meticulously examines the reported work since 2000. The collected data have also helped propose future directions, and the research gap needs to be filled to provide a more rapid, sensitive, and accurate measurement of ocular pH in eye clinics. For the first time, this review consolidates current techniques and recent advancements in ocular pH detection, offering a strategic overview to propel ophthalmic-related research forward and enhance ocular burn management during a chemical spillage.
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Affiliation(s)
- H H P Benuwan Sandaruwan
- Department of Biosystems Technology, Faculty of Technology, University of Sri Jayewardenepura, Pitipana North, Homagama 10206, Sri Lanka.
| | - Danushika C Manatunga
- Department of Biosystems Technology, Faculty of Technology, University of Sri Jayewardenepura, Pitipana North, Homagama 10206, Sri Lanka.
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Renuka N Liyanage
- Department of Materials and Mechanical Technology, Faculty of Technology, University of Sri Jayewardenepura, Pitipana North, Homagama 10200, Sri Lanka
| | | | - Rohan S Dassanayake
- Department of Biosystems Technology, Faculty of Technology, University of Sri Jayewardenepura, Pitipana North, Homagama 10206, Sri Lanka.
| | - Ruchire Eranga Wijesinghe
- Center for Excellence in Informatics, Electronics & Transmission (CIET), Sri Lanka Institute of Information Technology, Malabe, 10115, Sri Lanka
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Sri Lanka Institute of Information Technology, Malabe, 10115, Sri Lanka
| | - Yang Zhou
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemical Engineering and Technology, Hainan University, Haikou, Hainan 570228, China
| | - Yuanyuan Liu
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemical Engineering and Technology, Hainan University, Haikou, Hainan 570228, China
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2
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Matar H, Vuddanda PR, Chilcott RP. Evaluation of emergency skin decontamination protocols in response to an acid attack (vitreolage). Burns 2024; 50:1968-1976. [PMID: 38991894 DOI: 10.1016/j.burns.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/24/2024] [Accepted: 07/04/2024] [Indexed: 07/13/2024]
Abstract
The incidence of "acid attacks" (vitreolage) is a global concern, with those affected often receiving lifelong medical care due to physical and psychological damage. The purpose of this study was to evaluate the effectiveness of several emergency skin decontamination approaches against concentrated (>99 %) sulphuric acid and to identify the effective window of opportunity for decontamination. The effects of four decontamination methods (dry, wet, combined dry & wet and cotton cloth) were assessed using an in vitro diffusion cell system containing dermatomed porcine skin. Sulphuric acid (H2SO4) was applied to the skin with decontamination protocols performed at 10 s, 30 s, 8 min, and 30 min post exposure. Skin damage was quantified by tritiated water (3H2O) penetration, receptor fluid pH and photometric stereo imaging (PSI), with quantification of residual sulphur (by SEM-EDS) to determine overall decontamination efficiency. Skin translucency (quantified by PSI) demonstrated a time-dependent loss of dermal tissue integrity from 10 s. Quantification of dermal sulphur content confirmed the rapid (exponential) decrease in decontamination efficiency with time. The pH of the water effluent indicated complete neutralisation of acid from the skin surface after 90 s of irrigation. Wet decontamination (either alone or immediately following dry decontamination) was the most effective intervention evaluated, although no decontamination technique was statistically effective after 30 s exposure to the acid. These data demonstrate the time-critical consequences of dermal exposure to concentrated sulphuric acid: we find no practical window of opportunity for acid decontamination, as physical damage is virtually instantaneous.
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Affiliation(s)
- H Matar
- Research Centre for Topical Drug Delivery and Toxicology, University of Hertfordshire, Hatfield AL10 9AB, UK..
| | - P R Vuddanda
- Research Centre for Topical Drug Delivery and Toxicology, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - R P Chilcott
- Research Centre for Topical Drug Delivery and Toxicology, University of Hertfordshire, Hatfield AL10 9AB, UK
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Bélanger A, Pichette A, Gauthier M, Legault J. Diphoterine, an amphoteric rinsing solution, reduces hydrofluoric acid injuries in an ex vivo pigskin model. Burns 2024; 50:488-494. [PMID: 38087660 DOI: 10.1016/j.burns.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 02/24/2024]
Abstract
Hydrofluoric acid (HF) is a ubiquitous industrial chemical that is particularly hazardous because of the potential for systemic effects and the induction of severe cutaneous necrosis after contact with the skin. Minimizing skin injury requires decontaminating the affected area promptly with an emergency rinsing solution. Few experimental studies have objectively characterized rinsing solutions such as Diphoterine (DP). Here we develop an ex vivo pigskin model to study and compare the efficacy of rinsing solutions as initial decontaminating agents to stop the progression of skin lesions after HF splashing. The pigskin model shows an immediate local response to HF at varying concentrations and exposure times. We then exposed the pigskin biopsies to 3.75% HF for 1 min and rinsed them with different solutions, including water, 0.9% NaCl solution (saline), 10% calcium gluconate (CaG), Hexafluorine (HXF), and DP. We found DP to be a more effective agent for decontaminating HF lesions than water, saline, and CaG. DP had a similar efficacy as HXF, an emergency rinsing solution used specifically for decontaminating HF-exposed skin. This study shows that skin exposed to HF must be treated quickly from the first minute of exposure.
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Affiliation(s)
- Audrey Bélanger
- Laboratoire d'Analyse et de Séparation des Essences végétales (LASEVE), Département des Sciences fondamentales, Centre de recherche sur la boréalie (CREB), Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada.
| | - André Pichette
- Laboratoire d'Analyse et de Séparation des Essences végétales (LASEVE), Département des Sciences fondamentales, Centre de recherche sur la boréalie (CREB), Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada.
| | - Marcel Gauthier
- Laboratoire d'Analyse et de Séparation des Essences végétales (LASEVE), Département des Sciences fondamentales, Centre de recherche sur la boréalie (CREB), Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada.
| | - Jean Legault
- Laboratoire d'Analyse et de Séparation des Essences végétales (LASEVE), Département des Sciences fondamentales, Centre de recherche sur la boréalie (CREB), Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada.
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Hermans MHE. An Introduction to Burn Care: The Sequel. Adv Skin Wound Care 2024; 37:9-18. [PMID: 38117166 DOI: 10.1097/asw.0000000000000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
GENERAL PURPOSE To review burn care, with an emphasis on burn-specific issues and treatment. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Select the appropriate treatment guidelines for patients who have burn injuries.2. Identify common complications of major burns.3. Choose the recommended pharmacologic approaches to burn care.
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Affiliation(s)
- Michel H E Hermans
- Founder and President, Hermans Medical Consulting, Hoorn, the Netherlands
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5
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Akgun Z, Selver OB. Epidemiology and etiology of chemical ocular injury: A brief review. World J Clin Cases 2023; 11:1245-1251. [PMID: 36926138 PMCID: PMC10013112 DOI: 10.12998/wjcc.v11.i6.1245] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/19/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
Chemical ocular injury is one of the common ophthalmologic emergencies that can cause vision loss and serious complications. Despite all protective measures, it continues to be a serious public health problem, especially in young male patients. Although it is known that injuries occur most frequently in the workplace and in young male patients, there is a variable frequency and distribution in different regions around the world. In addition, with the coronavirus disease 2019 pandemic, there are changing trends in ocular chemical injuries. This review aims to specify an update on the epidemiological and etiological features of ocular chemical injuries.
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Affiliation(s)
- Zeynep Akgun
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir 35100, Turkey
| | - Ozlem Barut Selver
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir 35100, Turkey
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Dinesen F, Pape P, Vestergaard MR, Rasmussen LS. Diphoterine for Chemical Burns of the Skin: A Systematic Review. EUROPEAN BURN JOURNAL 2023; 4:55-68. [PMID: 39599970 PMCID: PMC11571839 DOI: 10.3390/ebj4010006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 11/29/2024]
Abstract
The incidence of chemical burns appears to be increasing. Diphoterine is an amphoteric, chelating, polyvalent solution used for the decontamination of chemical splashes. In this systematic review, we aimed to assess the effect of diphoterine on chemical burns compared with water or no treatment. The primary endpoint was the depth of burn, and secondary outcomes included pain, duration of hospitalization, time to return to work, need for surgery, pH, and complications. PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar were systematically searched using the terms "Diphoterine", "Previn", and ""Amphoteric solution" AND "burn"". A total of nine studies were included. One study evaluated the depth of chemical burns and found no difference between the diphoterine group and the control group. Four studies reported on pain, three of which found a more pronounced decrease in pain when using diphoterine compared to the control groups. Two studies found a significant neutralization of pH when using diphoterine. No differences were found for the remaining endpoints. Based on the very low certainty of evidence, this systematic review reports no observed difference between diphoterine and water or no treatment on the depth of a chemical burn. Diphoterine appeared to be associated with less pain and to have a neutralizing effect.
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Affiliation(s)
- Felicia Dinesen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Section 6011 Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Pernille Pape
- Department of Anaesthesia, Centre of Head and Orthopaedics, Section 6011 Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Martin Risom Vestergaard
- Department of Anaesthesia, Centre of Head and Orthopaedics, Section 6011 Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Lars Simon Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Section 6011 Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark
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Veronese S, Brunetti B, Minichino AM, Sbarbati A. Vacuum and Electromagnetic Fields Treatment to Regenerate a Diffuse Mature Facial Scar Caused by Sulfuric Acid Assault. Bioengineering (Basel) 2022; 9:799. [PMID: 36551005 PMCID: PMC9774184 DOI: 10.3390/bioengineering9120799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Acid attacks are on the rise, and they cause extensive and deep burns, especially on the face. The treatments used to improve the aesthetic, functional and social impact of non-acid scars do not always prove useful for acid scars. This article reports the case of a woman with an extended, mature, acid facial scar, caused by sulfuric acid assault, treated with a recent new procedure that combines the application of vacuum and electromagnetic fields. Before and after the treatment, the aesthetic appearance, and motor function of the face and neck were evaluated, as well as the level of hydration, the amount of sebum, the elasticity, and the pH of the skin. The improvements highlighted after the treatment of the aesthetic and functional characteristics of the face and neck, and of the physical parameters of the skin seemed to indicate that this particular treatment induces tissue regeneration, even in the nerve component. However, it is evident that the rehabilitation pathways of facial wounds and scars must be personalized, and must include continuous psychological support for the patient.
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Affiliation(s)
- Sheila Veronese
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | | | | | - Andrea Sbarbati
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
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8
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Letter to the editor: Pragmatic and novel approach to E-cigarettes battery related burns. J Plast Reconstr Aesthet Surg 2021; 75:893-939. [PMID: 34924328 DOI: 10.1016/j.bjps.2021.11.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/21/2021] [Accepted: 11/11/2021] [Indexed: 11/22/2022]
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Nahaboo Solim MA, Lupion-Duran TM, Rana-Rahman R, Patel T, Ah-Kine D, Ting DSJ. Clinical outcomes and safety of Diphoterine ® irrigation for chemical eye injury: A single-centre experience in the United Kingdom. Ther Adv Ophthalmol 2021; 13:25158414211030429. [PMID: 34350381 PMCID: PMC8287404 DOI: 10.1177/25158414211030429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: Diphoterine® is an amphoteric irrigating solution armed with rapid
pH-neutralising action. It serves as an effective first-aid treatment for
managing chemical burns, including chemical eye injury (CEI). However, its
use is not widely adopted in current clinical practice, primarily attributed
to limited clinical evidence. This study aims to highlight the experience in
using Diphoterine for managing CEI in a UK tertiary referral centre. Methods: This retrospective case series included all patients who presented with CEI
and treated with Diphoterine at the James Cook University Hospital, UK,
between April 2018 and February 2020. Results: Seven patients (10 eyes) were included; the mean age was 28.2 ± 17.0 years
(ranged, 3–70 years) and 85.7% were male. All patients presented with an
alkaline injury with a mean presenting pH of 8.7 ± 0.7 and a median
(±interquartile range [IQR]) corrected-distance visual acuity (CDVA) of
0.10 ± 0.28 logMAR. Based on Roper-Hall classification, 90% and 10% of the
eyes were of grade-I and -IV CEI, respectively. All eyes received normal
saline/water as the first irrigation fluid and Diphoterine as second
irrigation fluid. The mean pH improved slightly after first irrigation
(8.4 ± 0.7; p = 0.13) and significantly after second
irrigation (7.6 ± 0.4; p = 0.001). The volume of irrigation
used was significantly less for Diphoterine (520 ± 193 mL) than for normal
saline/water (2700 ± 2451 mL; p = 0.016). At final
follow-up (median = 5 days), the median CDVA remained stable at 0.10 ± 0.28
logMAR (p = 0.60). One patient developed near-total limbal
stem cell deficiency as a complication of grade-IV injury and was awaiting
limbal stem cell transplantation at last follow-up. Conclusion: This study represents the first case series in the United Kingdom, reporting
the use of Diphoterine in managing CEI. The rapid pH-neutralising action of
Diphoterine, with less volume required, makes it an ideal initial treatment
for efficiently managing adult and paediatric patients with CEI in
clinics.
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Affiliation(s)
| | | | - Romeela Rana-Rahman
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
| | - Trushar Patel
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
| | - Desiree Ah-Kine
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
| | - Darren S J Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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10
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Erste Hilfe. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Paediatric chemical burns: a clinical review. Eur J Pediatr 2021; 180:1359-1369. [PMID: 33403450 DOI: 10.1007/s00431-020-03905-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/05/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Although they account for a small proportion of burns in paediatrics, injuries from chemicals can be just as devastating as other mechanisms of burn injury. At least 25,000 chemicals exist which can cause burns: in children, they are often caused by household chemicals via accidental exposure. The mechanism by which corrosive substances produce chemical burns highlights the importance of early and plentiful irrigation of the burn area, removal of contaminated clothes and careful clinical assessment. Surgical intervention is uncommon but often follows the principles for thermal burns. This article reviews the aetiology, incidence, clinical presentation, management, complications and prevention of chemical burns. What is Known • Chemical burns in paediatrics are often caused by accidental exposure to chemicals available at home • Differences in the pathophysiology of chemical burns reinforces the need for early irrigation What is New • New irrigation fluids show promise in adults and need further study in children • The nature of chemical cutaneous burns can make assessment of wound depth difficult. Laser Doppler Imaging (LDI) is an accurate technique that can be used clinically to determine burn depth in thermal burns and is an area of future interest in the assessment of chemical burns.
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Zideman DA, Singletary EM, Borra V, Cassan P, Cimpoesu CD, De Buck E, Djärv T, Handley AJ, Klaassen B, Meyran D, Oliver E, Poole K. European Resuscitation Council Guidelines 2021: First aid. Resuscitation 2021; 161:270-290. [PMID: 33773828 DOI: 10.1016/j.resuscitation.2021.02.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The European Resuscitation Council has produced these first aid guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics include the first aid management of emergency medicine and trauma. For medical emergencies the following content is covered: recovery position, optimal positioning for shock, bronchodilator administration for asthma, recognition of stroke, early aspirin for chest pain, second dose of adrenaline for anaphylaxis, management of hypoglycaemia, oral rehydration solutions for treating exertion-related dehydration, management of heat stroke by cooling, supplemental oxygen in acute stroke, and presyncope. For trauma related emergencies the following topics are covered: control of life-threatening bleeding, management of open chest wounds, cervical spine motion restriction and stabilisation, recognition of concussion, cooling of thermal burns, dental avulsion, compression wrap for closed extremity joint injuries, straightening an angulated fracture, and eye injury from chemical exposure.
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Affiliation(s)
| | | | - Vere Borra
- Centre for Evidence-based Practice, Belgian Red Cross, Mechelen, Belgium; Cochrane First Aid, Mechelen, Belgium
| | - Pascal Cassan
- International Federation of Red Cross and Red Crescent, France
| | - Carmen D Cimpoesu
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Emergency Department and Prehospital EMS SMURD Iasi Emergency County Hospital "Sf. Spiridon" Iasi, Romania
| | - Emmy De Buck
- Centre for Evidence-based Practice, Belgian Red Cross, Mechelen, Belgium; Cochrane First Aid, Mechelen, Belgium; Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Therese Djärv
- Department of Medicine Solna, Karolinska Institute and Division of Acute and Reparative Medicine, Karolinska University Hospital, Sweden
| | | | - Barry Klaassen
- Emergency Medicine, Ninewells Hospital and Medical School Dundee, UK; British Red Cross, UK
| | - Daniel Meyran
- French Red Cross, Bataillon de Marins Pompiers de Marseille, France
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Proposition d’un protocole standardisé de prise en charge aux urgences générales d’une projection oculaire d’un corrosif. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2020.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Clinical Manifestations, Treatment, and Prevention of Acute Irritant Contact Dermatitis Caused by 2,4-Dichloro-5-Methylpyrimidine. Dermatitis 2021; 32:63-67. [PMID: 31688132 PMCID: PMC7813440 DOI: 10.1097/der.0000000000000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background There are no reported cases of 2,4-dichloro-5-methylpyrimidine (DCP)–induced irritant contact dermatitis (ICD). Objective The aim of the study was to summarize the clinical features, treatment, and protective measures for DCP-induced ICD. Methods We retrospectively reviewed the clinical data from 64 patients with DCP-induced ICD and the protective measures in a DCP manufacturing factory. Results Disease onset occurred 1 to 10 minutes after DCP single exposure in all 64 patients. The contact site developed edematous erythematous skin lesions with clear boundaries. Other symptoms included a burning sensation (n = 48), pruritus (n = 16), headache (n = 4), nausea/vomiting (n = 3), and syncope (n = 1). Ten patients developed pruritic rash over the whole body 1 to 4 days after contacting DCP. Histopathologic examination of the lesions was performed in 8 patients; all 8 showed manifestations of ICD. A patch test with 1% DCP ethanol solution was performed in 7 patients. One patient withdrew because of pruritus and massive erythema over the whole body. Four patients had a strong reaction, and 2 patients had a very strong reaction. All patients were cured. Positive-pressure inflatable protective clothing protected workers from the outside environment to prevent DCP-induced ICD. Conclusions 2,4-Dichloro-5-methylpyrimidine exposure induces acute ICD and a delayed allergic reaction in some patients (15.6%). Positive-pressure inflatable protective clothing prevents DCP-induced ICD.
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15
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Vyncke T, De Wolf E, Hoeksema H, Verbelen J, De Coninck P, Buncamper M, Monstrey S, Claes KEY. Injuries associated with electronic nicotine delivery systems: A systematic review. J Trauma Acute Care Surg 2020; 89:783-791. [PMID: 32590554 DOI: 10.1097/ta.0000000000002834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since its introduction on the market in 2007, the number of reports on injuries caused by the overheating, ignition, or explosion of electronic nicotine delivery systems (ENDSs) has increased significantly. These injuries appear to have different causes, the most important one being lithium-ion battery overheating to the point of ignition or explosion. METHODS A literature search for all relevant studies concerning ENDS-related traumatic injuries of all kinds was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol. The search started with the first introduction of ENDSs in 2007 and ended February 2020. Articles included were reports on patients who sustained flame, chemical, or traumatic injuries of the skin, soft tissue, and/or bone, related to the use of ENDSs. RESULTS This systematic review includes 180 patients from 41 case series and reports, published between 2016 and 2020. The mean age was 30.8 years (range, 17-59 years) with an overall male predominance (168 of 180 patients, 93%). In most injuries, multiple anatomical sites were affected, with the thigh/lower limb being the most commonly injured area (77%) followed by the upper limb/hand (43%). Eighty-two patients (51%) required a surgical treatment, 70 patients (43%) were managed conservatively with dressings or ointments, and 9 patients (6%) underwent enzymatic debridement. Thirty-five percent of all patients underwent skin grafting. CONCLUSION Injuries from overheating, ignition, or explosion of ENDSs are an emerging, underreported, and underresearched issue. There is a need for increased regulation of ENDSs and improved surveillance of related injuries. Both health care providers and consumers should be made aware of the risks and be advised about how to safely handle these devices. In contrast to other articles, this systematic review includes all types of injuries related to ENDS overheating, ignition, and explosion. To our knowledge, this is the most extensive systematic review performed to date. LEVEL OF EVIDENCE Review article, level III.
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Affiliation(s)
- Tom Vyncke
- From the Ghent University Hospital (T.V., E.D.W., H.H., J.V., P.D.C., M.B., S.M., K.E.Y.C.); and Ghent Burn Center (H.H., J.V., P.D.C., S.M., K.E.Y.C.), Ghent, Belgium
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Claes KEY, Vyncke T, De Wolf E, Hoeksema H, Verbelen J, Monstrey S. Enzymatic debridement as an effective treatment for combined flame and chemical burns caused by e-cigarettes. Am J Emerg Med 2020; 38:1199-1202. [PMID: 32139205 DOI: 10.1016/j.ajem.2020.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/17/2022] Open
Abstract
Since its introduction on the market in 2007, the number of reports on injuries caused by the ignition or explosion of electronic nicotine delivery systems (ENDS) has increased significantly. Two male patients have been treated at our burn center, the for ENDS-related injuries. Their batteries came into contact with metal objects stored in their pants pockets, resulting in a short circuit and finally ignition. In both patients, the combined flame and chemical burn wounds were initially irrigated with water upon arrival at the emergency department, leading to increased levels of pain. In our burn center, the wounds were extensively cleansed which led to a subsequent drop in NRS-scores. Laser Doppler Imaging showed a clear indication for surgery as both patients suffered a partial-thickness burn, with one patient having a patch of full-thickness burn as well. We swiftly performed an enzymatic debridement in both patients, followed by conservative wound management. Although enzymatic debridement is not generally recommended in the treatment of chemical burns, we successfully made use of this treatment option. Different authors advocate the use of mineral oils to irrigate or cover alkali burns, as contact between the chemical compounds and water can set off an exothermic reaction, leading to further injury. We believe that a hypertonic rinsing solution could be recommended as well in an emergency setting and we want to stress the importance of rapid removal of the chemical compounds in suspected chemical burns as well as swift debridement.
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Affiliation(s)
- Karel E Y Claes
- Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent Burn Center, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Tom Vyncke
- Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Edward De Wolf
- Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Henk Hoeksema
- Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent Burn Center, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Jozef Verbelen
- Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent Burn Center, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Stan Monstrey
- Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent Burn Center, C. Heymanslaan 10, 9000 Ghent, Belgium.
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Lewis CJ, Hodgkinson EL, Allison KP. Corrosive attacks in the UK - Psychosocial perspectives and decontamination strategies. Burns 2019; 46:213-218. [PMID: 31784238 DOI: 10.1016/j.burns.2019.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 10/25/2022]
Abstract
Acid attacks, or vitriolage, are defined as violent assaults involving the deliberate throwing of an acid or similarly corrosive substance with the intention to "maim, disfigure, torture or kill" [1]. The Acid Survivors Trust International suggest a prevalence of 1500 attacks reported worldwide per annum, although this is likely to be an underestimate by 40% [2]. The UK is thought to have one of the highest of rates of recorded corrosive attacks, with an increase from 228 attacks in 2012 to 601 in 2016. Most were reported by the London Metropolitan police force followed by Northumbria, Cambridgeshire, Hertfordshire, Greater Manchester and Humberside [[2]]. The chemical agents involved include acids, alkalis, oxidising and reducing agents, alkylating and chelating agents and solvents. They cause injury by producing a chemical interaction which can lead to extensive tissue destruction and extreme pain. Herein, we present a review on the changing epidemiology of corrosive attacks in the UK and currently employed management strategies.
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Affiliation(s)
- C J Lewis
- Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, UK.
| | - E L Hodgkinson
- Psychology in Healthcare, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - K P Allison
- Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, UK
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Kulkarni P, Jeffery S. The effects of the use of Diphoterine® solution on chemical burns in the Tarapur industrial complex, India. BURNS OPEN 2018. [DOI: 10.1016/j.burnso.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Lewis CJ, Allison KP. Response to 'Chemical burns: Diphoterine untangled' by KS Alexander [Burns 2017]. Burns 2018; 44:1011-1012. [PMID: 29397237 DOI: 10.1016/j.burns.2017.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Christopher J Lewis
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
| | - Keith P Allison
- Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
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The discordant relationship between acid attack incidence and advances in management. Burns 2018; 44:236-237. [DOI: 10.1016/j.burns.2017.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 11/20/2022]
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Alexander KS, Wasiak J, Cleland H. Chemical burns: Diphoterine untangled. Burns 2017; 44:752-766. [PMID: 29029860 DOI: 10.1016/j.burns.2017.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/01/2017] [Accepted: 09/15/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Diphoterine is a hypertonic, amphoteric, polyvalent and chelating decontamination solution used in the treatment of cutaneous and ocular chemical burns. Due to infrequent use by emergency physicians along with the small number of available studies, its debate in the literature as to its efficacy and safety remains inconclusive. METHODS A structured literature search was performed in MEDLINE, EMBASE BIOLOGICAL ABSTRACTS and TOXNET to June 2016 for original English-language studies reporting on the safety and effectiveness of Diphoterine. Methodological and reporting quality of pre-clinical animal studies was assessed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) risk of bias tool and Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. Clinical studies were assessed using Chambers' criteria. RESULTS 13 studies (seven in the pre-clinical, five in the clinical setting and one mixed) met the study inclusion criteria. Pre-clinical studies showed a faster resolution of pH and reduced tissue necrosis with Diphoterine. Clinical studies showed reduced tissue necrosis/severity of symptoms, faster pH resolution and a reduction in pain when using Diphoterine. No adverse events were attributable to Diphoterine. Reporting and methodology of the studies was poor or showed a high risk of bias. CONCLUSIONS Diphoterine appears to be safe to use and is probably superior to other rinsing solutions. However, immediate decontamination is imperative and if Diphoterine is not available a different rinsing solution should be used. The methodology of the published literature for Diphoterine is generally poor and future publications should use the frameworks given as templates.
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Affiliation(s)
- K Skaria Alexander
- Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Jason Wasiak
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia
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