povidone-iodine and Burns--Chemical

This manuscript highlights and critically analyses clinical and forensic signs related to chemical burns. Signs that may lead to suspicion of a particular chemical are thoroughly discussed regarding its underlying mechanisms. Burns due to sulfuric, hydrofluoric, nitric, hydrochloric (muriatic) and acetic (including derivatives) acids, hydrogen sulphide, sodium (caustic soda) and calcium (cement) hydroxides, paraquat, burns after inflation and rupture of airbags, povidone-iodine, chlorhexidine/alcohol (in preterm infants), laxatives, and vesicants (warfare agents), will be reviewed since these are the most common agents found in daily practice, for which relevant and timed information may be helpful in formulating an emergency treatment protocols and toxicological analysis.

Topics: Acetic Acid; Acids; Air Bags; Air Pollutants; Anti-Infective Agents, Local; Bone Cements; Burns, Chemical; Calcium Hydroxide; Caustics; Chemical Warfare Agents; Chlorhexidine; Explosive Agents; Forensic Medicine; Herbicides; Humans; Hydrochloric Acid; Hydrogen Sulfide; Irritants; Laxatives; Nitric Acid; Paraquat; Povidone-Iodine; Sodium Hydroxide

Chemical burn under pneumatic tourniquet caused by povidone-iodine is an iatrogenic injury and is rarely reported in the literature. It is even rarer in paediatric cases. We report a case of 2-year-old female patient who underwent excision and reconstruction of bilateral radial polydactylies. She was found with chemical burns over posterior aspect of both arms later. These wounds healed secondarily within 4 weeks. This morbidity is relatively under-recognised. Special attention should be paid to paediatric patients, whose skins are more delicate and vulnerable.

Topics: Anti-Infective Agents, Local; Arm; Burns, Chemical; Female; Humans; Infant; Plastic Surgery Procedures; Polydactyly; Povidone-Iodine; Tourniquets

Burns are a rare but potentially serious complication of povidone-iodine use. This rare adverse drug reaction developed in a 38-year-old woman who underwent laparoscopic right ovarian cystectomy and endometrial ablation as a day procedure involving application of the topical antiseptic 10% povidone-iodine solution. Two days later, the patient was admitted to the hospital with burning, pain, itching, marked redness, and blistering extending from her midback to buttocks. A stain on her back also was evident. Partial-thickness chemical burn was diagnosed. Review of the literature yielded 13 other cases of povidone-iodine-induced burn. This underrecognized adverse effect of povidone-iodine application typically occurs when the povidone-iodine has not been allowed to dry or has been trapped under the body of a patient in a pooled dependent position. The burn is usually seen immediately after the procedure or on the next day, and typically heals with minimum scarring within 3-4 weeks with conservative treatment. The commonly postulated mechanism is a chemical burn due to irritation coupled with maceration, friction, and pressure. Given the widespread use of povidone-iodine and the potential for development of infection after a burn, clinicians need to be aware of this possible povidone-iodine-associated adverse drug reaction, and of preventive measures.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacitracin; Burns, Chemical; Female; Humans; Polymyxin B; Povidone-Iodine

Topics: Aged; Anti-Infective Agents, Local; Arthroplasty, Replacement, Knee; Burns, Chemical; Erythema; Humans; Male; Povidone-Iodine; Tourniquets

Topics: Anti-Infective Agents, Local; Burns, Chemical; Fingers; Gloves, Surgical; Hand Disinfection; Humans; Povidone-Iodine

Chemical burn is a rare complication of topical polyvinylpyrrolidone-iodine (PVP-I), commonly called povidone-iodine (trade name Betadine, Purdue, Stamford, NJ). This adverse reaction occurred on the buttocks of an eight-year-old male after undergoing a laparoscopic appendectomy involving antiseptic skin preparation using a 10% PVP-I solution. This case is consistent with previous reports in which a chemical burn develops when PVP-I does not adequately dry, pools beneath a dependent body part during surgery, or is placed under an occlusive device. Symptoms develop immediately to one day after surgery. The proposed mechanism is irritation from iodine coupled with maceration, pressure and friction. While patients typically heal without significant scarring, the burn subjects the patient to unnecessary pain, prolongs hospitalization and increases the risk for infection. Physicians should be aware of this complication and therefore take preventative measures. These include allowing PVP-I to completely dry, preventing dripping and pooling and avoiding occlusion.

Topics: Administration, Topical; Anti-Infective Agents, Local; Burns, Chemical; Child; Humans; Male; Povidone-Iodine

Topics: Achilles Tendon; Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anti-Infective Agents, Local; Burns, Chemical; Female; Humans; Iatrogenic Disease; Knee Injuries; Male; Orthopedic Procedures; Povidone-Iodine; Thigh; Tourniquets

Burns associated with chemical disinfectants for skin preparation are rare. Skin irritation and maceration associated with pressure factors may contribute to its occurrence. We report a 24-year-old female with thyroid tumor who was admitted for subtotal thyroidectomy. After anesthetic induction, the patient was placed in the supine position with the trunk elevated to 20 degree. The skin over the anterior neck was sterilized with 10% Povidone-iodine (PI) alcohol solution. After a 3-hour surgery, the patient complained of burning pain over the back at the recovery room. Physical examination revealed a 9 x 11 cm area of skin lesion partially thickened amid on the middle of the back suggestive of chemical burn. After conservative treatment, she was discharged uneventfully 4 days later. Upon follow-up, the wound was seen to heal with minimal scarring within 3 weeks.

Topics: Adult; Anti-Infective Agents, Local; Back; Burns, Chemical; Female; Humans; Povidone-Iodine; Thyroid Neoplasms; Thyroidectomy

Skin preparation burns associated with chemical agents are uncommon. They occur most frequently in patients placed in the lithotomic position undergoing gynaecologic or urologic operations, the burn being on the buttocks, and in those undergoing orthopaedic operations, the burn being on the extremities and under a tourniquet. The basic mechanism involves irritation coupled with maceration and pressure. If the betadine solution has not been allowed to dry and has been trapped under the body of the patient in a pooled dependent position, such as the buttocks or under a tourniquet, the solution may irritate the skin and result in a skin burn. The irritation coupled with pressure leads to a situation analogous to that seen in the development of an acute accelerated decubitus ulcer; irritation, maceration, friction and pressure compounding each other to result in a skin burn or superficial ulcer in the skin. Our experience with three illustrative patients who presented with various burns following exposure to povidone-iodine (betadine) is described below.

Topics: Administration, Topical; Adult; Aged; Anti-Infective Agents, Local; Burns, Chemical; Follow-Up Studies; Humans; Male; Middle Aged; Povidone-Iodine; Risk Assessment; Surgical Procedures, Operative; Tourniquets

Mustard gas (sulfur mustard, HD) is a powerful vesicant employed as a chemical weapon. The present study demonstrates the effect of povidone iodine (PI) ointment against skin toxicity caused by HD. Gross and histopathological examinations showed that application of PI 20 min or less following exposure to the vesicant resulted in marked skin protection. The shorter, interval between exposure and treatment, the better was the protection achieved. Povidone iodine was also effective against other mustards, such as carboxybutylchloroethyl sulfide (CBCS) and mechlorethamine. The fact that PI protected the skin against agents that cannot be oxidized, such as iodoacetic acid, divinylsulfone and cantharidine, indicated that the antidotal effect of PI was unrelated to oxidation of the nitrogen and sulfur atoms of the mustards. Furthermore, NMR spectroscopy of CBCS treated with iodine did not show oxidation of the sulfur atom. Clinical experience with patients after accidential heat burns (mostly of grade I) has shown that topical application of PI ointment immediately after the stimulus significantly reduced, and often prevented, skin lesions. Apart from being a safe and widely used disinfectant, PI ointment is recommended as an efficient protective agent against skin toxicity caused by hazardous chemicals and by heat stimuli.

Topics: Administration, Topical; Animals; Anti-Infective Agents, Local; Burns; Burns, Chemical; Dermatologic Agents; Guinea Pigs; Male; Mustard Gas; Povidone-Iodine; Protective Agents

Topics: Adult; Anti-Infective Agents, Local; Burns, Chemical; Dermatitis, Irritant; Female; Humans; Male; Middle Aged; Povidone-Iodine

The management of burns has shown substantial progress over the years. The application of an effective topical agent improves the healing rate of burns. Betadine cream and ointment have been used in all the burn admissions since 1986. The data collected over 10 years are analysed in this report. All the burn patients admitted were evaluated and the factors investigated included patient age, sex, cause of injury, extent of burn wound, length of hospital stay, bacteriology, multi-organ failure and mortality. A total of 6,056 patients were admitted to a 40-bed unit during the 10-year period. Sixty-two percent were adults and 37% children. There were 67.5% males and 32.5% females. Eighty-one percent were admitted directly to the unit. Intensive/high care admissions accounted for 19.2% patients. The major cause of injury was accidental scalding in 34.2% patients, and the majority (65.4%) stayed between 1 and 4 weeks in hospital. There were 452 deaths. This audit reviewing 6,056 sequential burn cases represents a 10-year experience of burn management, using Betadine cream and ointment as topical agent.

Topics: Accidents; Administration, Cutaneous; Adult; Age Factors; Anti-Infective Agents, Local; Burns; Burns, Chemical; Cause of Death; Child; Child, Preschool; Critical Care; Female; Hospitalization; Humans; Infant; Infant, Newborn; Iodophors; Length of Stay; Male; Medical Audit; Multiple Organ Failure; Ointments; Patient Admission; Povidone-Iodine; Sex Factors; South Africa; Survival Rate; Wound Healing

Povidone-iodine (PVP-I) is a widely used antiseptic because of its low toxicity and high germicidal effect. A one-year-old boy who had undergone Nissen's fundoplication developed a chemical burn on his back postoperatively. The lesion was exposed to the surgical sheet immersed with a large amount of 10% PVP-I solution for 4 hours. Patch test with PVP-I (small aluminum chamber keeps a wet paper with PVP-I) revealed positive response in the patient. The same patch tests were performed in 17 volunteers. Sixteen subjects showed positive and one negative, while direct painting of a small quantity of PVP-I on skin without the chamber produced negative responses. This may indicate that prolonged exposure to wet PVP-I is harmful. It is important to use PVP-I carefully for the prevention of contact dermatitis.

Topics: Burns, Chemical; Humans; Infant; Male; Povidone-Iodine

Topics: Burns, Chemical; Ethanol; Extremities; Humans; Infant; Postoperative Complications; Povidone-Iodine; Tourniquets

Our experience with infrequent and unfamiliar types of injury caused by various compounds of bromine are described and discussed. While bromine containing compounds share some of the characteristics of other common causes of chemical burns, they also have a specific, exclusive mode of affecting the skin. The delay in the appearance of clinical signs and symptoms is an important factor to be considered by those who treat injuries caused by bromine or some of its compounds, or by those who may be the first to see persons who are injured by these agents. As most of the injuries occur at work (92 per cent) it is in these industrial premises that considerable stress should be made of the importance of wearing protective clothing in order to reduce local damage and prevent systemic effects. Prompt first aid, by thorough washing with large volumes of water reduces the extent and depth of the injury.

Topics: Accidents, Occupational; Adult; Bromine; Burns, Chemical; Burns, Inhalation; Chemical Phenomena; Chemistry; Female; Foot Injuries; Hand Injuries; Humans; Male; Middle Aged; Povidone-Iodine; Silver Sulfadiazine

We present the cases of three patients with skin blisters following carbon monoxide (CO) poisoning. Their blisters appeared to be related to the severity of the poisoning (HbCO levels of more than 40%). Two of the three patients died despite aggressive initial 100% surface oxygen followed by hyperbaric oxygen therapy. The pathophysiology of this type of blister remains unresolved. It could result from pressure necrosis alone or from a combination of pressure necrosis and direct CO inhibition of tissue oxidative enzymes. Although skin involvement as a result of CO poisoning is less frequently reported today than in the past (perhaps because of misidentified burns or because of more aggressive resuscitation and treatment protocols), the physician should recognize that such blisters may signal severe CO poisoning.

Topics: Adolescent; Aged; Blister; Burns, Chemical; Carbon Monoxide Poisoning; Carboxyhemoglobin; Emergencies; Female; Hemoglobins; Humans; Male; Middle Aged; Oxygen; Povidone-Iodine; Resuscitation

Topics: Burns, Chemical; Female; Humans; Occlusive Dressings; Plastics; Povidone; Povidone-Iodine; Pregnancy

Skin preparation burns associated with chemical agents are uncommon. They occur most frequently in those patients placed in the lithotomy position undergoing gynecologic operations, the burn being on the buttocks, and in those undergoing orthopedic operations, the burn being on the extremities and under a tourniquet. Thimerosal has been the most common agent to be implicated. The basic mechanism involves irritation coupled with maceration and pressure--conditions that can cause an acute pressure sore and superficial skin loss. To prevent these burns from occurring, the skin must not be abraded excessively before the final skin preparation solution is applied; the agent should not be allowed to pool and become trapped under the tourniquet or the torso of the patient, and the agent should be allowed to dry before the patient is draped. In our experience, the agent that has been the most effective and the least irritating to the skin during the time it has been used is povidone-iodine.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Burns, Chemical; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Povidone-Iodine; Skin; Thimerosal