Diphoterine^® for alkali splashes to the skin

(In response to the recent review article: Brent J. Water based solutions are the best decontaminating fluids for dermal corrosive exposures. Clin Toxicol 2013;51:731–736.)

To the Editor:

I am writing to correct two misinterpretations in the recent review article on decontaminating fluids for dermal corrosive exposures.¹ The article reviewed a paper I authored on Diphoterine^® for alkali skin splashes.² In brief, the paper compared the clinical outcomes of alkali skin splashes in two groups – one of which applied Diphoterine^® first and the other applied water first before using Diphoterine^®.²

The review article states that the median time to irrigation was different in these two groups (1 vs. 5 min; p < 0.001) and that the group using Diphoterine^® first decontaminated significantly faster than the group using water first. However, it was the median time to Diphoterine^® application that was different, precisely because the water-first group chose to apply water first, before they applied Diphoterine^®. It is likely the two groups commenced irrigating either with Diphoterine^® or water at a similar time after alkali splash because emergency showers are very quickly accessible at the alumina refineries where they were working and workers are trained to decontaminate immediately. It should therefore not be assumed that the better clinical outcomes observed following the use of Diphoterine^® first, were due to a delay in decontamination in the “water first” group.

The second issue is that the review article raises the concern that workers with larger and potentially more serious skin splashes might have chosen to use water first because of their longstanding familiarity with aqueous decontamination prior to the introduction of Diphoterine^®. As the review article points out, this was an issue I raised in the paper; but the review does not mention that the difference between the two groups in median percentage body surface area splashed by alkali was small and not statistically significant. It is therefore unlikely that the better clinical outcomes observed following the use of Diphoterine^® first were due to a difference in the size of skin splashes between the two groups.

Finally, a clarification. The review article stated the specific alkali(s) involved were not stated. As explained in the paper, all of the clinical cases were exposed to alkali solutions, which in an alumina refinery primarily contain sodium hydroxide.

Declaration of interest

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