An uncommon burn

Abstract

SIR, We report a rare case of inhaler-induced burn in a 13-year-old boy caused by applying the nozzle of the inhaler to his hand and discharging the inhaler.A 13-year-old boy presented with a 4-day history of blisters around the edge of an erythematous patch on the dorsum of his left hand, which had been present for a year. His sister suffered from asthma. On examination, there was a welldemarcated erythematous patch on the dorsum of his left hand with crusts from ruptured blisters around the edge of the patch (Fig. 1). On further questioning, he admitted having developed this red patch 1 year previously after he had applied the nozzle of his sister's salbutamol inhaler onto his hand and discharged it a few times playfully. The repetition of this practice had resulted in the inhaler-induced burns we see in this picture.Inhaler-induced burn is very rare, and to our knowledge there are only three cases reported in the literature. 1-3 All three patients were asthmatic. Chemical burn from the pharmaceutical ⁄preservative ⁄propellant aerosol, cold injury to the skin or mechanical abrasive effect of the aerosol blasts were the suggested mechanisms of injury. Burge et al. suggested that the physical signs of inhaler-induced burn are similar to those seen after a standardized cryotherapy freeze injury to the skin. 4 Children who gain access to inhalers may find them to be interesting toys. They could then sustain chemical burns due to inappropriate discharge onto the skin. We need to be aware of this effect of commonly used inhalers and warn parents, teachers and children in order to avoid these injuries.

Accidental Cutaneous Burns Secondary to Salbutamol Metered Dose Inhaler

“…A 14-year-old girl with self-induced areas of hypo- and hyperpigmentation on her forearm as a result of applying ten blasts of an asthmatic aerosol inhaler directly to her skin has also been reported [ 2 ]. Similar salbutamol inhaler-induced burn injuries in children have been reported by Patel and Potter [ 3 ] and Arun et al [ 4 ].…”

Jailhouse self‐induced lesions by misuse of salbutamol inhaler

“…Deliberate misuse of salbutamol inhaler in order to self‐inflict skin injuries has been reported in the literature mostly among kids and teenagers, usually because of psychological distress or just for fun . We report a case in an adult inmate in order to have a “pseudo‐tattooed” letter on his skin.…”

“…Several cases of self‐induced skin burns of the hands and upper limbs have been reported after misuse of salbutamol inhaler. They are either performed in a context of psychological distress and deliberate self‐harm or as a “recreational” activity, usually in school in the company of several other schoolmates . Mechanisms and reasons for such behavior are usually revealed after questioning the patient.…”

Salbutamol inhaler misuse resulting in skin burn

“…[1][2][3][4] Skin injury may appear in the form of isolated or multiple spots on a distinct area of the body surface. 4 Deliberate aerosol-induced skin injury was reported in the context of Munchausen syndrome.…”