Extensive chemical burns from toluene.

A 22-year-old man with heavy, generalized exposure to a toluene-based paint developed extensive chemical burns on approximately 71% of his total body surface area followed by acute renal failure and disseminated intravascular coagulation that led to death. Although the skin damage initially appeared mild, it was followed by blistering, extensive necrosis, and massive loss of fluid. Histological examination of the skin showed findings similar to those observed in second-degree thermal burns. Although the most common toxic effects of toluene are depression of central nervous system activity, irritation of mucous membranes, and hepatic or renal dysfunctions, emergency physicians should be aware of the risk of skin toxicity. Therefore, it is important to irrigate the exposed skin immediately and vigorously.