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Bitumen burns and the use of baby oil
363
Bitumen burns and the use of baby oil A. Juma The Plastics and Bums Unit, The Royal Preston
Hospital,
Preston,
Lancashire,
UK
This case report describes the successful use of baby oil to remove bitumen from burned skin.
Bums (1994) 20, (4), 363-364.
Introduction Hot bitumen is used mainly to surface roads, tiling roofs in houses, waterproofing cars and other industries. Between 1.6 and 3.0 per cent of bum patients admitted to USA burn units have bitumen tar injurie?. Many substances have been used to remove this highly sticky compound, and include butte?, De-Solv-It (a citrus petroleum distillate with surfactant and lanolina), mayonnaise4 and neomycin sulphate with polyoxethylene sorbitan as a base’. Other agents such as alcohol, acetone and kerosene have had limited use*. These compounds are highly toxic in large quantities with harsh effects on the injured skin. Bitumen removal with these agents had been a labour- and time-consuming process taking up to 12-48 h in some caseso**. Furthermore some of these agents needed a great amount of rubbing leading to more damage to an already injured skin. Here we report two examples of bitumen burns admitted to the Burns Unit at The Royal Preston Hospital. These were treated with NISA baby oil (NISA/Today Ltd, Scunthorpe, South Humberside, UK), which removed the bitumen most effectively.
Case reports Case 1 A 47-year-old labourer while working surfacing a motorway had boiling bitumen tar splatter on his face, his forearm and hand, involving 4 per cent total body surface area. NISA Baby Oil was used effectively to remove the bitumen. This was by surface application and once the bitumen dissolved it was washed with tepid water and mild soap. This only took 1-1.5 h. The patient was discharged 24 h after admission (Figures I, 2). Case
2
A 25-year-old truck driver was involved in a local road surfacing when boiling bitumen was splashed on him by accident, affecting his right arm, chest wall and face in patchy areas with a total body surface area of I per cent. NISA baby oil was used to remove this effectively in an hour. The patient was discharged the same day of admission. 0
1994 Butterworth-Heinemann
0305-4179/94/040363-02
Ltd
Figure I. Patient with bitumen tar prior to application of baby
oil.
Discussion Bitumen tar is made from distillates of petroleum composed of long chain hydrocarbons and waxes* which have a high boiling point. The boiling points of paving bitumen and roof tiling bitumen are 140°C and 232°C respectively”“. Hence roofing accidents tend to be associated with deeper burns. When the tar splatters it cools to 93’C’**. On contact it creates a deep bum due to heat transfer. Bitumen is sterile on impact with the skin. As it acts as an occlusive dressing the skin beneath the bitumen becomes colonized by organisms from the surrounding intact skin. A high
Bums (1994) Vol. to/No.4
364
depth of the patient’s bums. NISA baby oil contains M70 liquid paraffin as an active ingredient; it also contains 0.017 per cent ‘pretty peach perfume. In such a small percentage the perfume is unlikely to act as an irritant. Liquid paraffin, like bitumen, is a hydrophobic molecule. When mixed the bitumen is dissolved, and the new compound formed is hydrophilic which makes it easy to wash away. NISA baby oil is easily available, cheap, gentle, non-toxic even in ‘large quantities’, and has proved to be pain and irritation free when used for this purpose. From this limited experience we recommend a prospective randomized clinical trial to study the effectiveness of baby oil versus other compounds used in other studies.
Acknowledgements I would like to thank Mr J. K. G. Laitung, ch~, FRCS, Consultant Plastic Surgeon at The Royal Preston Hospital, Preston, Lancashire for helping me to prepare this article.
References
Figure 2. Patient after application of NISA Baby oil.
infection rate in bitumen bums has been postulatedzf6. Though the use of neomycin sulphate had been described, adverse effects attributed to, the use of large quantities have been noted in the literature7*8. Treatment regimens can be vanable and have included leaving the tar to solidify and to peel off9. Other methods include mechanical removal which can be both painful and traumatizing. The initial treatment of bitumen bums is like any other, with the first aid aiming to reduce the effect of the thermal insult1*z’5. In cases where the bitumen tar is left to dry and peel off, it is hard to assess the depth of the injury. This could mean longer hospital stay with its impact on hospital resources and the patient’s earning capacity. NISA baby oil, in our experience, has been found to be highly effective in the removal of bitumen tar from the two patients in this short series. The manner of application proved swift, painless, allowing us early assessment of the
Schiller WR. Tar bums in the Southwest. Stlrg. Gynecol Obstet 1983;157:38. Stratta RJ, Saffle JR, Kravitz M et al. Management of tar and asphalt injuries. Am J Surg 1983;146:766-769. Tieman E and Harris A. Butter in the treatment of hot tar bums. Burns 1993; 19: 437-438. Shea PC Jr and Fannon P. Mayonnaise and hot tar bums. J Med Assoc Gu 1981;70:659-660. Demling RH, Buerstatte RPH and Perea A. Management of hot tar bums. ] Truttma 1980;20:242. Ashbell TS, Crawford HH, Adamson JE et al. Tar and grease removal from injured parts. Plusf Reconsfr Surg 1967; 40: 330-331. Mandell GL, Douglas GR and Bennet JG. Principles and Practice of lnfecfiow Diseases, 3rd edn. Edinburgh: Churchill Livingstone, 1990. Greenwood D. Antimicrobial Chemotherapy, 2nd edn. Oxford: Oxford Medical Publications, 1989. Kemble JVH, Lamb BE. Prucficul Bums Munugement, 1st edn. London: Hodder and Stoughton, 1987.
Paper accepted
15 December
1993.
Correspondence should be addressed to: Mr A. Juma, The Plastics and Burns Unit, Stoke Mandeville Hospital, Aylesbury, Bucks HP21 8AL, UK.
Bitumen burns and the use of baby oil A. Juma The Plastics and Bums Unit, The Royal Preston
Hospital,
Preston,
Lancashire,
UK
This case report describes the successful use of baby oil to remove bitumen from burned skin.
Bums (1994) 20, (4), 363-364.
Introduction Hot bitumen is used mainly to surface roads, tiling roofs in houses, waterproofing cars and other industries. Between 1.6 and 3.0 per cent of bum patients admitted to USA burn units have bitumen tar injurie?. Many substances have been used to remove this highly sticky compound, and include butte?, De-Solv-It (a citrus petroleum distillate with surfactant and lanolina), mayonnaise4 and neomycin sulphate with polyoxethylene sorbitan as a base’. Other agents such as alcohol, acetone and kerosene have had limited use*. These compounds are highly toxic in large quantities with harsh effects on the injured skin. Bitumen removal with these agents had been a labour- and time-consuming process taking up to 12-48 h in some caseso**. Furthermore some of these agents needed a great amount of rubbing leading to more damage to an already injured skin. Here we report two examples of bitumen burns admitted to the Burns Unit at The Royal Preston Hospital. These were treated with NISA baby oil (NISA/Today Ltd, Scunthorpe, South Humberside, UK), which removed the bitumen most effectively.
Case reports Case 1 A 47-year-old labourer while working surfacing a motorway had boiling bitumen tar splatter on his face, his forearm and hand, involving 4 per cent total body surface area. NISA Baby Oil was used effectively to remove the bitumen. This was by surface application and once the bitumen dissolved it was washed with tepid water and mild soap. This only took 1-1.5 h. The patient was discharged 24 h after admission (Figures I, 2). Case
2
A 25-year-old truck driver was involved in a local road surfacing when boiling bitumen was splashed on him by accident, affecting his right arm, chest wall and face in patchy areas with a total body surface area of I per cent. NISA baby oil was used to remove this effectively in an hour. The patient was discharged the same day of admission. 0
1994 Butterworth-Heinemann
0305-4179/94/040363-02
Ltd
Figure I. Patient with bitumen tar prior to application of baby
oil.
Discussion Bitumen tar is made from distillates of petroleum composed of long chain hydrocarbons and waxes* which have a high boiling point. The boiling points of paving bitumen and roof tiling bitumen are 140°C and 232°C respectively”“. Hence roofing accidents tend to be associated with deeper burns. When the tar splatters it cools to 93’C’**. On contact it creates a deep bum due to heat transfer. Bitumen is sterile on impact with the skin. As it acts as an occlusive dressing the skin beneath the bitumen becomes colonized by organisms from the surrounding intact skin. A high
Bums (1994) Vol. to/No.4
364
depth of the patient’s bums. NISA baby oil contains M70 liquid paraffin as an active ingredient; it also contains 0.017 per cent ‘pretty peach perfume. In such a small percentage the perfume is unlikely to act as an irritant. Liquid paraffin, like bitumen, is a hydrophobic molecule. When mixed the bitumen is dissolved, and the new compound formed is hydrophilic which makes it easy to wash away. NISA baby oil is easily available, cheap, gentle, non-toxic even in ‘large quantities’, and has proved to be pain and irritation free when used for this purpose. From this limited experience we recommend a prospective randomized clinical trial to study the effectiveness of baby oil versus other compounds used in other studies.
Acknowledgements I would like to thank Mr J. K. G. Laitung, ch~, FRCS, Consultant Plastic Surgeon at The Royal Preston Hospital, Preston, Lancashire for helping me to prepare this article.
References
Figure 2. Patient after application of NISA Baby oil.
infection rate in bitumen bums has been postulatedzf6. Though the use of neomycin sulphate had been described, adverse effects attributed to, the use of large quantities have been noted in the literature7*8. Treatment regimens can be vanable and have included leaving the tar to solidify and to peel off9. Other methods include mechanical removal which can be both painful and traumatizing. The initial treatment of bitumen bums is like any other, with the first aid aiming to reduce the effect of the thermal insult1*z’5. In cases where the bitumen tar is left to dry and peel off, it is hard to assess the depth of the injury. This could mean longer hospital stay with its impact on hospital resources and the patient’s earning capacity. NISA baby oil, in our experience, has been found to be highly effective in the removal of bitumen tar from the two patients in this short series. The manner of application proved swift, painless, allowing us early assessment of the
Schiller WR. Tar bums in the Southwest. Stlrg. Gynecol Obstet 1983;157:38. Stratta RJ, Saffle JR, Kravitz M et al. Management of tar and asphalt injuries. Am J Surg 1983;146:766-769. Tieman E and Harris A. Butter in the treatment of hot tar bums. Burns 1993; 19: 437-438. Shea PC Jr and Fannon P. Mayonnaise and hot tar bums. J Med Assoc Gu 1981;70:659-660. Demling RH, Buerstatte RPH and Perea A. Management of hot tar bums. ] Truttma 1980;20:242. Ashbell TS, Crawford HH, Adamson JE et al. Tar and grease removal from injured parts. Plusf Reconsfr Surg 1967; 40: 330-331. Mandell GL, Douglas GR and Bennet JG. Principles and Practice of lnfecfiow Diseases, 3rd edn. Edinburgh: Churchill Livingstone, 1990. Greenwood D. Antimicrobial Chemotherapy, 2nd edn. Oxford: Oxford Medical Publications, 1989. Kemble JVH, Lamb BE. Prucficul Bums Munugement, 1st edn. London: Hodder and Stoughton, 1987.
Paper accepted
15 December
1993.
Correspondence should be addressed to: Mr A. Juma, The Plastics and Burns Unit, Stoke Mandeville Hospital, Aylesbury, Bucks HP21 8AL, UK.