May 18, 2000 -- Soft and Beautiful, Dark and Lovely: The names of these products suggest a romantic rendezvous on a moonlit night.
But for children who get into these hair relaxers, the rendezvous can take place in an emergency room, and there's nothing romantic about it. These products, and many other hair relaxers like them, contain what are known as "alkaline caustics." These substances can cause a chemical burn similar to what might happen when a person comes into contact with a strong acid.
Yet, in a chemical sense, they are completely different. Acids and alkalines lie on opposite sides of the 14-point pH scale. The lower you go on the scale, the stronger the acid. The higher you go, the stronger the alkaline. Substances that land in the middle have a pH close to what's normally found in the body.
Hair relaxers have pHs in the 11 to 13 range, and, as a recent report in the journal Pediatrics notes, they commonly cause burns when accidentally eaten or smeared on the skin. The report's author, Daniel A. Rauch, MD, is calling on pediatricians to inform parents about the potential dangers of these products after he treated four children injured by them -- one of them seriously. Rauch is with the department of pediatrics and Jacobi Medical Center/Albert Einsten College of Medicine in the Bronx, N.Y.
"The most important thing is, he's highlighting that these are extremely caustic chemicals, and because of the way they're promoted -- as containing 'no lye' -- people may not think they are dangerous products," says Rosanne Soloway of the American Association of Poison Control Centers in Washington.
But they certainly can be, says Harold Simmons, R&D chemist at Bronner Brothers in Atlanta, a leading manufacturer of hair relaxers. "As with any chemical you use, you really don't want kids in the same room ... because all it takes is just a second."
Simmons says there's just a small difference in pH between "lye" and "no lye" relaxers. The latter contain ingredients such as calcium hydroxide, he says, and must be activated by adding a solution. Burns from these products might take a little more time to develop, but they will. Lye relaxers, on the other hand, contain sodium hydroxide and act more quickly.
How bad can alkaline burns get? Gary Wasserman, MD, chief of the medical toxicology section at Children's Mercy Hospital in Kansas City, Mo., still remembers one from nearly 30 years ago. It involved a 2-year-old who got a taste of a caustic-cleaning agent, and suffered severe burns all through his esophagus and stomach, Wasserman tells WebMD. Over the years, the child underwent about a hundred medical procedures to deal with the extensive scarring. The injuries were so bad that doctors eventually created a new esophagus and stomach pouch using a portion of his bowel. He's in good shape today, Wasserman says.
Other products that can cause alkaline burns include bleach, oven cleaners, and toilet cleaners.
Scarring is the ultimate outcome of an alkaline burn, and small areas of scar tissue can be surgically removed. But drug treatment for these burns is still somewhat hit-or-miss. "Drug therapy is a little bit controversial, whether you give them steroids or antibiotics," Wasserman says. "Steroids interfere with scar formation ... but they can subject the patient to infection."
As for immediate home treatment of a child who has swallowed an alkaline solution, Wasserman says there is one main thing to remember: "If they're not choking, give a drink of milk or water. If they are, don't." The main worry is that the child might take into the lungs any additional fluid they can't swallow. That could set up a dangerous, and even fatal, form of pneumonia.
But as with any home poisoning, before doing anything, parents should contact the local poison control center.
Upon arriving at the emergency room, it may seem to parents as if the doctors aren't really doing much to a child who has swallowed these substances. Their first goal is to make sure the child is not in an immediately life-threatening situation that might require him to be put on a ventilator or other such measures. After that, doctors will try to perform a procedure called endoscopy, in which a specialist puts a camera down the child's esophagus to see the extent of the burns. Further treatment will depend on what the specialist sees there.
One hair stylist was surprised to hear that relaxers have severely burned children. Nicole Cumberlander, owner of Noire Et Blanc Salon and Spa in Cleveland, says she's gone up to 20 minutes with relaxer on her hands and suffered no ill effects.
Still, she thinks "do-it-yourself relaxing" is a bad idea: "I'm a licensed stylist, and I don't even relax my own hair. There's no way you can do it yourself and get good results. ... And take it a step further, dealing with the issue of children."
- Parents should take precautions to keep hair relaxers and other potentially dangerous household products away from children, because they can cause chemical burns if eaten or smeared on the skin.
- If a child does accidentally swallow hair relaxer, call the poison control center and give him milk or water to drink if he is not choking.
- Scarring can be the ultimate outcome of these chemical burns, and small areas of scar tissue can be surgically removed.