Sir,

A 35-year-old construction worker was referred having sustained molten bitumen burns when a road paving heater pipe loosened. He complained of an inability to open his left eye and facial pain. The burn had been irrigated immediately with large amounts of cold water for several minutes. On examination he had a 2.5% body area burn to the face (Figure 1a) and 1% to the hands.

Figure 1
figure 1

(a–c) Butter dissolving hardened bitumen.

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Butter was allowed to soften to room temperature, applied directly onto the hardened bitumen (Figure 1b), gently mixed together and bitumen dissolved (Figure 1c). Using cotton buds the mixture was gently lifted off the skin. After 60 min later no visible bitumen remained (Figure 2a); exposing second-degree/partial thickness burns of red, mottled appearance with swelling and weeping of burst blistered surfaces (Figure 2b). His visual acuity, corneal, and ophthalmic assessment was otherwise normal. He was admitted for airway observation, given simple analgesics, no dressings, and clear fluids.

Figure 2
figure 2

(a–c) Skin bitumen removed, residues precipitated.

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Hand burns were seen by a plastic surgeon. Facial scabs showing brownish trace residue precipitation at 1 week (Figure 2c) and healed without cicatrisation, pigmentation, contracture, or infection.

Bitumen is heated to 232C1 for spray application and lower temperatures for road paving. When splattered, the temperature drops to 93–104C.1 Molten bitumen cools to form a hardened water-resistant residue. A hardened surface coating, strongly adherent to underlying skin, characteristically covers thermal burns from bitumen. In a series of 92 bitumen burns,2 25% affected the critical areas of face, orbit, hands, and feet; 42% required surgical debridement and grafting. Bitumen skin residues persist.3

Bitumen is widely recognised as an occupational hazard and after topical application, bitumen-based paints induce DNA adducts in cells of adult and fetal human skin samples maintained in short-term tissue culture and inhibits human epidermal keratinocytes intercellular communication in a concentration-dependent fashion, an important effect of tumour promoters.4 We are unaware of any studies of periocular neoplastic transformation. Oxidised or air-modified bitumen is classified as a possible human carcinogen with inadequate epidemiological evidence of a causal association for human cancers due to poor exposure data and potential confounders. Mice studies show increases in the incidence of skin and lung tumours.5

Facial Butt butter,6 vegetable7 and baby oil8 have been reported as treatment in other bitumen burns with moist exposed burn ointment (MEBO) a suggested adjunct;9 all contain a lipid solute to hardened bitumen. Rapid assessment enables early deep burn excision and grafting.