Acid scars are a severe form of chemical burn injury resulting from contact with highly corrosive acidic substances. These injuries damage the skin and underlying tissues, often leading to deep, complex wounds. The resulting scarring can cause significant cosmetic deformities and functional impairments, especially when the burns occur over joints or the face. Addressing these injuries requires immediate emergency intervention followed by long-term medical and surgical management to restore function and improve appearance.
Understanding Chemical Burns and Acid Injury
Acidic substances, defined by a low pH, cause damage through coagulation necrosis. When a strong acid, such as sulfuric acid found in drain cleaners or car batteries, contacts the skin, it rapidly denatures proteins in the tissue. This denaturation forms a thick, leathery, coagulated layer called an eschar on the surface of the burn site.
This protective eschar limits the acid’s ability to penetrate deeper into the underlying tissue, differentiating it from alkaline burns that cause liquefaction necrosis. The severity of the injury depends on the acid’s concentration, the volume of the substance, and the duration of contact. Strong industrial acids like hydrochloric or nitric acid can cause full-thickness destruction of the skin layers, even with limited penetration.
Characteristics of Acid Scars
Deep tissue damage from severe acid exposure results in full-thickness injuries. Since the entire dermis and often underlying structures are destroyed, the wound cannot heal naturally and requires surgical intervention, such as skin grafting. This destruction leads to the most severe and complex scar types.
The most debilitating outcome is the formation of contracture scars, where healing tissue tightens and restricts the movement of joints, the neck, or the hands. Acid burns also frequently develop into hypertrophic scars, which are raised, thickened, and often itchy areas confined to the original wound boundary. In some cases, the scar tissue can overgrow the original wound margins, forming a keloid scar.
Immediate First Aid and Emergency Response
Immediate first aid is crucial for limiting the depth of an acid burn and minimizing scar severity. The priority is to stop the chemical reaction quickly by removing the corrosive agent from the skin. Contaminated clothing and jewelry must be removed while decontamination begins.
The affected area must be flushed immediately with cool, running water for a minimum of 15 to 20 minutes. This prolonged irrigation helps to dilute and wash away residual acid from the tissue. It is important to avoid attempting to neutralize the acid with an alkaline substance, as this chemical reaction can generate heat and worsen the initial burn damage. Emergency medical services must be contacted immediately, particularly if the burn is large, deep, or involves sensitive areas like the eyes, face, hands, or major joints.
Long-Term Scar Revision and Management
Managing established acid scars requires a multidisciplinary approach combining non-surgical therapies with reconstructive procedures. Non-surgical options are initiated early in the healing process to modulate scar tissue formation. Silicone gel sheeting and topical gels are used to increase scar hydration, softening and flattening the tissue.
Custom-fitted pressure garments, applying consistent compression of approximately 24 millimeters of mercury, are often worn for many months to reduce the collagen production responsible for hypertrophic scarring. For scars that remain thick and inflamed, a physician may use corticosteroid injections directly into the scar tissue to decrease thickness and alleviate symptoms like itching. Laser therapy, including fractional carbon dioxide lasers, can also remodel the collagen structure of the scar, improving its texture, color, and pliability.
Surgical intervention becomes necessary when scarring restricts movement or causes cosmetic deformity. Skin grafting is a common technique, where healthy skin is transplanted to replace the damaged, scarred area after removal. Surgeons may employ a Z-plasty procedure, which involves making Z-shaped incisions to redistribute tension along a tight scar line, lengthening it and improving flexibility, particularly near joints. For larger defects, tissue expansion is another option, where a balloon-like device is placed beneath healthy, adjacent skin and gradually inflated to grow extra skin for eventual repair.
Preventing Acid Exposure and Injury
Preventing acid scars begins with safety protocols when handling corrosive chemicals. Strong acidic cleaners, such as toilet bowl or drain cleaners, should always be stored in their original, clearly labeled containers in a secure location. This storage area should be kept low to the ground and locked, preventing accidental access by children or pets.
When using these agents, personal protective equipment (PPE) is necessary to create a barrier against splashes and fumes. This includes wearing chemical-resistant gloves, such as those made of nitrile or butyl rubber, and full-seal safety goggles or a face shield. Adequate ventilation must also be ensured to prevent the inhalation of acid vapors and fumes.