Water-based solutions are the best decontaminating fluids for dermal corrosive exposures: A mini review

Abstract

Aim. The intention is to assess whether the fundamental principle (“the solution to pollution is dilution”) should be the guide for the initial medical management of corrosive dermal exposures. Methods. The US National Library of Medicine Pubmed database was searched utilizing all combinations of the search terms “decontamination”, “corrosive”, and “dermal”. A separate search was done specifically related to hydrofluoric acid. These searches found 69 relevant papers. Results. Only four controlled clinical studies comparing early and intensive water decontamination with no or less dilution treatment have been published on human corrosive dermal exposures. Although the authors’ conclusion in the first study of 273 patients was that those that had more intensive water irrigation tended to have less time to skin grafting and shorter periods of hospitalization, the results were not statistically significant. In the second study of 51 patients, those who had “adequate” decontamination (immediate dilution or neutralization therapy) had shortened length of stay (7.2 vs. 16.2 days), lower mortality (9.5% vs. 21%), and fewer skin grafts (19% vs. 36%) despite having slightly greater burn surface area (19.7% vs. 17.2%). However, no statistical analysis was provided. The third and fourth studies were conducted in the same center. In the third study of 35 patients, those who had “immediate” water lavage (done within 10 min of exposure and continued for at least 15 min) had significantly fewer burns that progressed to full thickness (12.5% vs. 63%; p < 0.01) and significantly shorter mean hospital stays (7.7 days vs. 20.5 days; p < 0.01) than those who did not, despite the mean total burn surface area being twice as large in the adequate water decontamination group (12% vs. 6%; p < 0.05). In the fourth study of 83 patients (35 of whom had been reported in the previous study), those who had copious water lavage within 3 min of injury were less likely to progress to full thickness burns (13.5% vs. 60.8%; p < 0.01), had fewer delayed complications (5.4% vs. 30.4%; p < 0.01) and shorter lengths of stay (6.2 vs. 22 days; p < 0.01), compared with those who did not. In a further study, water was compared to the proprietary agent Diphoterine^® in a controlled prospective cohort study of 180 dermal alkali exposures. The Diphoterine^® first group was decontaminated significantly faster than the water first group (median times to irrigation 1 vs. 5 min; p < 0.001). No analysis adjusted for time to decontamination was provided, so the study demonstrated that only those individuals who decontaminated early did better than those who decontaminated later. Conclusions. The data support water as the best decontaminating solution. It has been shown to be efficacious in clinical trials, is widely available, and inexpensive.

Keywords:

• Corrosive dermal exposures
• Diphoterine^®
• Water decontamination

Acknowledgments

The author would like to acknowledge very helpful conversations and discussions about this topic with Drs. Frank Walter and Mark Kirk and the excellent editorial suggestions of Professor Allister Vale. Also profound thanks to Dr. Howard Maibach for his gracious participation in the debate from which this mini-review is derived.

Declaration of interest

The author reports no declarations of interest. The author alone is responsible for the content and writing of the paper.

Notes

^† The full set of publications identified through the above strategy is available from the author.