SYMPTOMS Subjective symptoms (burning, stinging, or smarting) can occur within seconds after exposure (immediate-type stinging), e.g., to acids, chloroform, and methanol. Delayed-type stinging occurs within 1 to 2 min, peaking at 5 to 10 min, fading by 30 min, and is caused by agents such as aluminum chloride, phenol, propylene glycol, and others. In delayed ICD, objective skin symptoms do not start until 8 to 24 h after exposure (e.g., anthralin, ethylene oxide, and benzalkonium chloride) and are accompanied by burning rather than itching.
SKIN FINDINGS Minutes after exposure or delayed up to ≥24 h. Lesions range from erythema to vesiculation (Figs. 2-1 and 2-2) and caustic burn with necrosis. Sharply demarcated erythema and superficial edema, corresponding to the application site of the toxic substance (Fig. 2-1). Lesions do not spread beyond the site of contact. In more severe reactions, vesicles and blisters (Figs. 2-1 and 2-2) → erosions and/or even frank necrosis, as with acids or alkaline solutions. No papules. Configuration is often bizarre or linear ("outside job" or dripping effect) (Fig. 2-1).
Distribution. Isolated, localized, or generalized, depending on contact with toxic agent.