Case Report: Second-Degree Chemical Burn Following Glycolic Acid Application on Skin Recently Treated with Electrolysis

Case at a Glance

A 25-year-old male presented with a painful, non-healing chemical burn on his upper lip, which developed after applying a cosmetic glycolic acid product to the area three days after an electrolysis session.

Patient's Story

The patient, a 25-year-old male with no significant past medical history, sought advice for a skin injury on his upper lip. He reported having an electrolysis hair removal session on the area approximately ten days prior to presentation. Two to three days after the procedure, in an attempt to improve skin texture, he applied a commercial glycolic acid solution to the treated skin. He immediately experienced intense pain and developed what he described as a 'horrible burn.' Over the following week, the lesion showed no signs of improvement. The patient was particularly distressed by the persistent pain and the appearance of the skin, which he described as feeling 'very hard with a harsh, uneven texture' and having 'holes in the skin surface' with yellow spots. He was concerned that the acid had penetrated deeply into the skin through the channels created by the electrolysis needle.

Initial Assessment

Upon presentation, a physical examination of the patient's perioral region, specifically the philtrum and upper lip, revealed a well-demarcated area of erythema and significant induration. The skin texture was markedly irregular and firm to the palpation. Multiple small, yellowish, crusted erosions were scattered across the affected area, consistent with the patient's description of 'yellow spots' and 'holes.' The patient reported significant tenderness upon light touch. His vital signs were stable, and there were no systemic symptoms of infection.

The Diagnostic Journey

The patient's history was key to the diagnosis. The timeline of events—electrolysis creating micro-injuries in the skin barrier, followed by the application of a known chemical exfoliant (glycolic acid)—led to a clear clinical diagnosis of a chemical burn. The skin's compromised state post-electrolysis allowed for deeper and more aggressive penetration of the acid than would occur on intact skin. The patient had previously consulted a dermatologist who, concerned about the risk of a secondary bacterial infection in the damaged tissue, prescribed a prophylactic antibiotic. The diagnostic focus was on assessing the depth of the burn and ruling out active infection.

Final Diagnosis

Second-Degree Chemical Burn, with delayed wound healing, secondary to the application of glycolic acid on a compromised skin barrier following electrolysis.

Treatment Plan

The patient's initial treatment with a prophylactic antibiotic was continued to prevent secondary infection. The treatment plan was expanded to include a comprehensive wound care regimen:

Gentle Cleansing: Use of a mild, non-irritating cleanser and water twice daily, followed by gentle patting to dry.
Moist Wound Healing: Application of a thick, occlusive ointment (e.g., petroleum jelly) to the affected area continuously to keep it moist, promote healing, and protect the new tissue.
Sun Protection: Strict avoidance of sun exposure and use of a broad-spectrum mineral sunscreen (once the skin was sufficiently healed to tolerate it) to prevent post-inflammatory hyperpigmentation (PIH).
Pain Management: Use of over-the-counter analgesics as needed for pain.
Avoidance: The patient was counseled to avoid all active or irritating skincare products, including exfoliants, retinoids, and fragrances, until the skin barrier was fully restored.

Outcome and Follow-up

The patient was scheduled for a follow-up appointment in two weeks to monitor the healing progress. He was educated that healing would likely be slow, taking several weeks, due to the nature of the chemical injury. He was advised that potential long-term sequelae could include textural irregularities, persistent erythema, and post-inflammatory hyperpigmentation, all of which could be addressed with further treatments (such as topical agents or laser therapy) once the initial wound had fully healed. Reassurance was provided that while the injury was significant, proper wound care would minimize the risk of permanent scarring.