Chemical Burns and Diapers Q&A
Chemical Burns
Author: Shan Yin, MD Medical Director, Drug and Poison Information Center, Cincinnati Children’s Hospital Medical Center, Assistant Professor, UC Department of Pediatrics
Q: What does a chemical burn look like?
A: Chemical burns will typically look similar to a burn one would get from a fire or hot scalding water. Depending on the severity of the burn, there could be some combination of redness or other skin discoloration, blistering, skin peeling, thick dark scabs, and swelling.
Q: What causes chemical burns?
A: Chemical burns are caused by chemicals which cause damage to the skin or other parts of the body on contact with those surfaces. The most common types of these chemicals are either acids or alkalis.
Q: What is the most common cause of chemical burns in children?
A: The most common cause of chemical burns in children comes from accidental exposure to household products, many of which are not intended for use by children. Typical products that may contain a corrosive substance are toilet bowl cleaners, drain cleaners, oven cleaners, dish washing detergents, liquid bleaches, and metal cleaners.
Q: What else could cause my child to have a rash that looks like a chemical burn?
A: Minor burns which generally just cause redness and pain at the site can look similar to other rashes that cause redness and irritation such as diaper rashes, allergic reactions, and skin infections. A health care professional can usually distinguish between these conditions.
Q: How do I know if my child may have a chemical burn?
A: Contact with household products that can cause chemical burns will typically cause immediate symptoms. Exposure to skin or eyes could cause redness, blistering, and pain. Oral exposures could cause swelling, drooling, difficulty swallowing, and vomiting.
Q: What should I do if I suspect my child may have a chemical burn?
A: If you suspect your child has suffered a chemical burn, you should immediately contact a health professional or the local poison control center. Depending on the size or location of the burn, the child may need to be immediately evaluated in an emergency department.
Q: How can I prevent a possible chemical burn?
A: Preventing exposure to household products not intended for children is the best way to prevent chemical burns. These products should be secured in cabinets with child safety locks. Product bottles should be immediately recapped and stored safely after use. Products should never be transferred to other bottles which do not contain child resistant closures or proper labeling.
Q: Where can I get more information about chemical burns?
A: More information about Chemical Burns is available at:
http://www.mayoclinic.org/first-aid/first-aid-chemical-burns/basics/art-20056667
Diapers Cannot Cause Chemical Burns
Author: Kara Shah, MD, PhD
Director, Division of Dermatology Cincinnati Children’s Hospital Medical Center, Associate Professor, UC Department of Pediatrics
Q: Can diapers cause chemical burns?
A: Diapers are composed of inert or non-reactive materials and cannot cause chemical burns.
Q: Why can’t diapers cause chemical burns?
A: A chemical burn results when skin or other areas such as the lips or mouth come in contact with something that is corrosive, such as a strong acid (has a low pH, such as drain cleaner) or a strong alkali (has a high pH, such as bleach). Diapers do not contain materials that result in the production of acidic or alkaline chemicals.
Q: Is there anything in stool or urine that can cause chemical burns?
A: Urine is mostly water with small amounts of urea, salts, and other usually non-irritating compounds. Therefore, urine is not likely to cause a chemical burn, though prolonged contact of the skin with urine may result in skin irritation. Stool contains numerous bacteria and enzymes that may cause skin irritation when there is prolonged contact with the skin, but this is different from a chemical burn.
Q: Can diaper rash look like a chemical burn?
A: Given that both chemical burns and diaper rash may result in skin redness and sometimes peeling in the diaper area, a diaper rash may mistakenly be attributed to a chemical burn. However, these are two very different processes and may require different courses of treatment.
Q: What else could cause my child to have a rash that looks like a chemical burn?
A: There are many causes of diaper rash, several of which may cause the skin in the affected area to become very red and sometimes to peel. These include irritation from stool and/or urine, infection (such as impetigo), and eczema. It is very important for your child’s healthcare provider to examine your child in order to determine the cause of the diaper rash and to treat it appropriately.
Q: If a child was having an allergic reaction to a diaper, would it look different than a chemical burn?
A: Allergic reactions to materials used in diaper construction are very rare. Since diapers are designed for babies, they contain materials that have been thoroughly evaluated and proven to be safe for babies’ delicate skin. With an allergic contact dermatitis reaction, the skin in the affected area would be expected to become red, itchy, and sometimes scaly or blistered. Less commonly, an allergic rash may result in the rapid development of itchy hives/welts.
Severe Diaper Rash
Author: Bernard Cohen, MD
Professor of Pediatrics and Dermatology, Johns Hopkins Children’s Center
Q: How common is diaper rash?
A: Diaper rash is extremely common and probably accounts for 25% of all visits to primary care providers for evaluation of rashes in babies and young children. Almost all babies will develop a mild diaper rash during the first year of life and with peak occurrence between the ages of 9-12 months.
Q: What does diaper rash look like?
A: The most common diaper rash shows redness and scaling in areas where the skin can become rubbed or irritated particularly on areas of such as the thighs, pubic area, and buttocks. The skin creases are less commonly affected.
Q: Can a diaper rash be severe?
A: Severe diaper rashes are much less common and probably account for far less than 10% of all diaper rashes seen by the primary care provider. Severe diaper rashes can be recognized by the presence of tenderness, open sores, red lumps, and infection with pus bumps. If the skin is sore enough, children may withhold urine and stool.
Q: What is the most common cause of severe diaper rash?
A: The most common cause of severe diaper rash is irritation from urine and stool especially in children with frequent stools or diarrhea. Children with sensitive skin and children taking oral antibiotics or with diarrhea caused by viral infections may be particularly at risk for developing severe diaper dermatitis.
Q: How do you know if rash is more than just a diaper rash?
A: In children with a rash in the diaper area that does not improve after treatment from the primary care provider, when pain from diaper rash is interfering with normal activities, in children with known underlying medical conditions, and in children who are not growing and developing normally, other conditions should be considered.
Q: How do you prevent and treat diaper rash?
A: The risk of developing diaper rash can be reduced by changing wet or soiled diapers frequently; gently cleaning the diaper area with water, soft wash cloths, or non-irritating disposable wipes; applying bland barrier ointment; using absorbent and lotion containing diapers; and using diapers that fit the baby well.
Q: When to call a physician if your child has a diaper rash?
A: Rarely persistent or chronic diaper rash may be a clue to an underlying medical illness or a sign of infection. Parents should call the primary care provider when diaper rash worsens despite preventative measures; when diaper rash is painful and interferes with daily activities including passing urine and stool; and when scabs, open sores and/or pus bumps appear.
Q: Where can I get additional information about diaper rash?
A: More information about diaper rash is available at:
https://www.healthychildren.org/English/ages-stages/baby/diapers-clothing/Pages/Diaper-Rash.aspx
http://www.mayoclinic.org/diseases-conditions/diaper-rash/multimedia/diaper-rash/img-20007114
Over the past several years, a number of articles and posts have circulated on the internet associating diapers, both disposable and cloth, with chemical burns on babies’ skin. These are misleading for parents and may potentially distract parents from proper treatment and prevention of diaper rash or actual chemical burns.
According to Dr. Shan Yin, Medical Director of the Drug and Poison Information Center at Cincinnati Children’s Hospital Medical Center, “Chemical burns are caused by chemicals that can damage the skin on contact, most commonly acids and alkalis.” The most common cause of chemical burns in children comes from accidental exposure to household products, many of which are not intended for use by children. Typical products that may contain a corrosive substance are toilet bowl cleaners, drain cleaners, oven cleaners, dish washing detergents, liquid bleaches, and metal cleaners.
Mild chemical burns generally cause redness and pain and can look similar to other rashes, which is why parents might confuse them with diaper rash or skin infections. Severe chemical burns may cause redness, blistering, skin peeling, and swelling. You may suspect a chemical burn if you see sudden, unexpected changes in the affected area of skin such as pain, itching, or redness (most chemical burns will cause immediate symptoms) and in particular if the child was near a container of one of the cleaning products mentioned above. If you suspect a chemical burn, contact a health care professional or poison control center immediately.
Diapers cannot cause chemical burns because they are made of inert materials – materials that do not create any chemical reaction. Disposable diapers are primarily made of polymers found in other consumer products like clothing, furniture upholstery, food containers, and paper products. The pH of disposable diapers is comparable to the pH of normal skin, meaning compared to skin they are neither acidic (low pH) nor alkali (high pH) so they cannot cause chemical burns.
One question parents ask is whether there is anything in urine or stool that can cause chemical burns or react with the diaper to cause a burn. Dr. Kara Shah, Director of the Department of Dermatology at Cincinnati Children’s Hospital Medical Center responds, “Urine is mostly water with small amounts of urea, salts, and other non-irritating compounds. Therefore, urine is not likely to cause a chemical burn, though prolonged contact of the skin with urine may result in skin irritation. Stool contains numerous bacteria and enzymes that may cause skin irritation when there is prolonged contact with the skin, but do not cause a chemical burn.”
This skin irritation from contact with urine or stool can cause diaper rash, which is the most common reason for redness in the diaper area. Diaper rash is extremely common. Almost all babies will develop diaper rash during the first year of life, with a peak occurrence between the ages of 9-12 months. Diaper rash commonly presents as redness and scaling in areas where the skin can become rubbed or irritated, particularly on areas such as the thighs, pubic area, and buttocks. A severe rash may also result in open sores, small red bumps, and oozing. Fortunately, severe diaper rashes are much less common and probably account for far less than 10% of all diaper rashes seen by the primary care provider.
However, the similarities between diaper rash symptoms and mild chemical burn symptoms may be the reason parents can be confused. According to Dr. Shah, “Given that both mild chemical burns and diaper rash may result in skin redness and sometimes peeling in the diaper area, a diaper rash may mistakenly be attributed to a chemical burn. However, these are two very different processes and may require different treatments, which is why it’s important to understand the difference.”
So when should a parent worry about a rash in the diaper area? Dr. Bernard Cohen, Professor of Pediatrics and Dermatology, Johns Hopkins Children’s Center advises parents, “Parents should call the primary care provider when diaper rash worsens despite preventative measures; when diaper rash is painful and interferes with daily activities including passing urine and stool; and when scabs, open sores and/or pus bumps appear. On rare occasions, persistent or chronic diaper rash may be a clue to an underlying medical illness or a sign of infection.”
Learn more:
How to Prevent Diaper Rash:
The most common cause of severe diaper rash is irritation from urine and stool especially in children with frequent stools or diarrhea. Children with sensitive skin and children taking oral antibiotics or with diarrhea caused by viral infections may be particularly at risk for developing severe diaper rash. The risk of developing diaper rash can be reduced by changing wet or soiled diapers frequently; gently cleansing the diaper area with water, soft wash cloths, or non-irritating disposable wipes; applying barrier ointments; using absorbent and lotion containing diapers; and using diapers that fit the baby well.
For more information on diaper rash:
https://www.healthychildren.org/English/ages-stages/baby/diapers-clothing/Pages/Diaper-Rash.aspx
http://www.mayoclinic.org/diseases-conditions/diaper-rash/multimedia/diaper-rash/img-20007114
How to Prevent Chemical Burns:
The most common cause of chemical burns in children comes from accidental exposure to household products, many of which are not intended for use by children. Typical products that may contain a corrosive substance are toilet bowl cleaners, drain cleaners, oven cleaners, dish washing detergents, liquid bleaches, and metal cleaners. Preventing exposure to the dangerous household products is the best way to prevent chemical burns. These products should be secured in cabinets with child safety locks. Product bottles should be immediately recapped and stored safely after use. These products should never be transferred to other bottles that do not contain child resistant closures and proper labeling. For more information on chemical burns:
http://www.mayoclinic.org/first-aid/first-aid-chemical-burns/basics/art-20056667
Chemical Burn Expert Statements:
Bernard Cohen, MD
Professor, Departments of Dermatology & Pediatrics, Johns Hopkins Medical School
Over the last several decades we have seen a dramatic decrease in the incidence of diaper rash as a result of the increased use of super absorbent diapers. However, diaper rash still occurs and should not be confused with chemical or thermal burns. Fortunately, extensive safety studies have led to the development of safe and effective diapers for our patients.
Kara Shah, MD, PhD
Director, Division of Dermatology Cincinnati Children’s Hospital Medical Center, Associate Professor, UC Department of Pediatrics
General
Despite the common misconception that diapers can cause chemical burns, an extensive review of the safety data available about the materials used in the manufacture of disposable diapers indicates that this is not true. There are no materials used in the construction of disposable diapers that either by themselves or in the presence of urine or stool can cause a chemical burn. Until they are toilet trained, infants and toddlers are prone to developing rashes in the diaper area due to irritation from urine and stool, and many other skin disorders may cause a rash in the diaper area that can resemble a burn.
Shan Yin, MD
Medical Director, Drug and Poison Information Center, Cincinnati Children’s Hospital Medical Center, Assistant Professor, UC Department of Pediatrics
General
As a pediatric emergency medicine physician and medical toxicologist, I have reviewed material and safety data for disposable diapers. Extensive safety testing is performed on these products by their manufacturers and there is no evidence that disposable diapers could cause or contribute to a chemical burn.