Dr Morgan Haines1, Dr Anthony Beard1
1The RNSH Department of Hand Surgery and Peripheral Nerve Surgery, St Leonards, Australia
Introduction: Chemical burns commonly affect the hand but are relatively rare in children. Warts, although benign and self-resolving, can be uncomfortable or cause concern through stigmatisation which leads many to use readily available topical wart removal agents. Here we report an iatrogenic chemical hand burn from a wart removal solution in a paediatric patient. Case report: A 2-year-old was referred for management of a non-healing full-thickness wound on the flexor surface of the left little finger proximal interphalangeal joint. The wound developed after repeated treatment with a salicylic acid impregnated wart removal disc over 2 months. The patient was referred for review of the wound and associated cellulitis. The wound was 8x8mm and full-thickness with flexor tendons visible at the wound base. The burn was debrided and managed non-operatively with weekly dressings as the wound granulated. The burn healed with restoration of normal finger function and contour. Conclusion: A review of the literature discovered 8 reports of full-thickness chemical burns secondary to wart removing agents. The causative agents were: salicylic acid (n=2), formic acid (n=3), monochloroacetic acid (n=1) and glutaraldehyde (n=1). 37.5% (3/8) of cases were managed with local flaps. Several solutions exist for wart removal, though none are recommended for use in children < 3 years. Therefore, prevention is key in the management of chemical burns in this population. If a wart remover induced acute burn is sustained, referral to a burns service for definitive management is required given the sensitive location of the injury on long term function.
Unaccredited Plastic Surgery Registrar at Royal North Shore Hospital