Burns caused by dilute hydrofluoric acid in the bleach.

Two male cleaning workers aged 62 (patient 1) and 28-(patient 2) presented with red, swollen, aching hands and fingers. At the first interview, the fingers of the right hand of both patients were swollen from the proximal interphalangeal joint to the tip of the finger. The fingers were red and intensely painful. The bleach that both patients used contained 9.5% hydrofluoric acid, and therefore we diagnosed their symptoms as those of burns caused by this agent. We subcutaneously injected 8.5% calcium gluconate into the affected fingers and dressed them with gauze soaked in cooled 0.025% benzethonium chloride. The patients did not use gloves at work, neither of them knew that the cleaning fluid contained dilute hydrofluoric acid, and they were unaware of the danger of this agent. They had not received proper education about the care and handling of poisons and deleterious substances such as hydrofluoric acid. The doctors who had examined the patients in the emergency ward overlooked the possibility of hydrofluoric acid burns, although they suspected chemical burns and confirmed the trade name of the cleaning agent. In addition, although the patients presented with intense pain, no white areas of coagulation and blistering, or surrounding erythemas, which are characteristic symptoms of such burns, were evident. The component of the cleaning agent was described on the container label in very small print. Had the words "poison" and "hydrogen fluoride" been printed in large characters, the examining doctors in the emergency ward would probably not have overlooked the presence of hydrofluoric acid, and the patients would perhaps have been more careful when using it. Hydrofluoric acid can be easily obtained by anyone through the Internet, although general consumers could not obtain industrial quantities. Therefore, the number of burn patients who are not familiar with hydrofluoric acid may increase in the future.