An atypical chemical burn.

A 48-year-old male painter visited the emergency room, in May, 1999, complaining of throbbing pain in the tip of his right index finger. He said that he always wore gloves while working, had had no previous trauma, smoked 25 cigarettes per day and used no medication. On examination, the fingertip had a blanched appearance, no capillary refill, and intact sensibility. We thought that he had an arterial embolus and started acetylsalicylic acid. He returned the next day complaining of increased pain. The fingertip had become black and necrotic, and the proximal finger was swollen and erythematous. Femoral angiography showed hyperaemia just proximal to the necrotic fingertip with no visible obstruction or embolus (figure). The patient then recalled that the previous day he had used a new cleaning fluid at his job. We called his employer who informed us that this fluid contained hydrofluoric acid. We applied calcium gluconate gel to the finger, repeating the application every 4 h for 3 days, until the pain ceased. His finger healed cleanly and he had no complaints when last seen in October, 2000.