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Deployed Airbag Causes Bullous Reaction Following a Motor Vehicle Accident
Airbags are lifesaving during motor vehicle accidents (MVAs), but their deployment has been associated with skin issues such as irritant dermatitis1; lacerations2; abrasions3; and thermal, friction, and chemical burns.4-6 Ocular issues such as alkaline chemical keratitis7 and ocular alkali injuries8 also have been described.
Airbag deployment is triggered by rapid deceleration and impact, which ignite a sodium azide cartridge, causing the woven nylon bag to inflate with hydrocarbon gases.8 This leads to release of sodium hydroxide, sodium bicarbonate, and metallic oxides in an aerosolized form. If a tear in the meshwork of the airbag occurs, exposure to an even larger amount of powder containing caustic alkali chemicals can occur.8
We describe a patient who developed a bullous reaction to airbag contents after he was involved in an MVA in which the airbag deployed.
Case Report
A 35-year-old man with a history of type 2 diabetes mellitus and chronic hepatitis B presented to the dermatology clinic for an evaluation of new-onset blisters. The rash occurred 1 day after the patient was involved in an MVA in which he was exposed to the airbag’s contents after it burst. He had been evaluated twice in the emergency department for the skin eruption before being referred to dermatology. He noted the lesions were pruritic and painful. Prior treatments included silver sulfadiazine cream 1% and clobetasol cream 0.05%, though he discontinued using the latter because of burning with application. Physical examination revealed tense vesicles and bullae on an erythematous base on the right lower flank, forearms, and legs, with the exception of the lower right leg where a cast had been from a prior injury (Figure 1).
Two punch biopsies of the left arm were performed and sent for hematoxylin and eosin staining and direct immunofluorescence to rule out bullous diseases, such as bullous pemphigoid, linear IgA, and bullous lupus. Hematoxylin and eosin staining revealed extensive spongiosis with blister formation and a dense perivascular infiltrate in the superficial and mid dermis composed of lymphocytes with numerous scattered eosinophils (Figures 2 and 3). Direct immunofluorescence studies were negative. Treatment with oral prednisone and oral antihistamines was initiated.
At 10-day follow-up, the patient had a few residual bullae; most lesions were demonstrating various stages of healing (Figure 4). The patient’s cast had been removed, and there were no lesions in this previously covered area. At 6-week follow-up he had continued healing of the bullae and erosions as well as postinflammatory hyperpigmentation (Figure 5).
Comment
With the advent of airbags for safety purposes, these potentially lifesaving devices also have been known to cause injury.9 In 1998, the most commonly reported airbag injuries were ocular injuries.10 Cutaneous manifestations of airbag injury are less well known.11
Two cases of airbag deployment with skin blistering have been reported in the literature based on a PubMed search of articles indexed for MEDLINE using the terms airbag blistering or airbag bullae12,13; however, the blistering was described in the context of a burn. One case of the effects of airbag deployment residue highlights a patient arriving to the emergency department with erythema and blisters on the hands within 48 hours of airbag deployment in an MVA, and the treatment was standard burn therapy.12 Another case report described a patient with a second-degree burn with a 12-cm blister occurring on the radial side of the hand and distal forearm following an MVA and airbag deployment, which was treated conservatively.13 Cases of thermal burns, chemical burns, and irritant contact dermatitis after airbag deployment have been described in the literature.4-6,11,12,14,15 Our patient’s distal right lower leg was covered with a cast for osteomyelitis, and no blisters had developed in this area. It is likely that the transfer of airbag contents occurred during the process of unbuckling his seatbelt, which could explain the bullae that developed on the right flank. Per the Centers for Disease Control and Prevention, individuals should quickly remove clothing and wash their body with large amounts of soap and water following exposure to sodium azide.16
In 1989, the Federal Motor Vehicle Safety Standard No. 208 (occupant crash protection) became effective, stating all cars must have vehicle crash protection.12 Prior to 1993, it was reported that there had been no associated chemical injuries with airbag deployment. Subsequently, a 6-month retrospective study in 1993 showed that dermal injuries were found in connection with the presence of sodium hydroxide in automobile airbags.12 By 2004, it was known that airbags could cause chemical and thermal burns in addition to traumatic injuries from deployment.1 Since 2007, all motor vehicles have been required to have advanced airbags, which are engineered to sense the presence of passengers and determine if the airbag will deploy, and if so, how much to deploy to minimize airbag-related injury.3
The brand of car that our patient drove during the MVA is one with known airbag recalls due to safety defects; however, the year and actual model of the vehicle are not known, so specific information about the airbag in question is not available. It has been noted that some defective airbag inflators that were exposed to excess moisture during the manufacturing process could explode during deployment, causing shrapnel and airbag rupture, which has been linked to nearly 300 injuries worldwide.17
Conclusion
It is evident that the use of airbag devices reduces morbidity and mortality due to MVAs.9 It also had been reported that up to 96% of airbag-related injuries are relatively minor, which many would argue justifies their use.18 Furthermore, it has been reported that 99.8% of skin injuries following airbag deployment are minor.19 In the United States, it is mandated that every vehicle have functional airbags installed.8
This case highlights the potential for substantial airbag-induced skin reactions, specifically a bullous reaction, following airbag deployment. The persistent pruritus and lasting postinflammatory hyperpigmentation seen in this case were certainly worrisome for our patient. We also present this case to remind dermatology providers of possible treatment approaches to these skin reactions. Immediate cleansing of the affected areas of skin may help avoid such reactions.
- Corazza M, Trincone S, Zampino MR, et al. Air bags and the skin. Skinmed. 2004;3:256-258.
- Corazza M, Trincone S, Virgili A. Effects of airbag deployment: lesions, epidemiology, and management. Am J Clin Dermatol. 2004;5:295-300.
- Kuska TC. Air bag safety: an update. J Emerg Nurs. 2016;42:438-441.
- Ulrich D, Noah EM, Fuchs P, et al. Burn injuries caused by air bag deployment. Burns. 2001;27:196-199.
- Erpenbeck SP, Roy E, Ziembicki JA, et al. A systematic review on airbag-induced burns. J Burn Care Res. 2021;42:481-487.
- Skibba KEH, Cleveland CN, Bell DE. Airbag burns: an unfortunate consequence of motor vehicle safety. J Burn Care Res. 2021;42:71-73.
- Smally AJ, Binzer A, Dolin S, et al. Alkaline chemical keratitis: eye injury from airbags. Ann Emerg Med. 1992;21:1400-1402.
- Barnes SS, Wong W Jr, Affeldt JC. A case of severe airbag related ocular alkali injury. Hawaii J Med Public Health. 2012;71:229-231.
- Wallis LA, Greaves I. Injuries associated with airbag deployment. Emerg Med J. 2002;19:490-493.
- Mohamed AA, Banerjee A. Patterns of injury associated with automobile airbag use. Postgrad Med J. 1998;74:455-458.
- Foley E, Helm TN. Air bag injury and the dermatologist. Cutis. 2000;66:251-252.
- Swanson-Biearman B, Mrvos R, Dean BS, et al. Air bags: lifesaving with toxic potential? Am J Emerg Med. 1993;11:38-39.
- Roth T, Meredith P. Traumatic lesions caused by the “air-bag” system [in French]. Z Unfallchir Versicherungsmed. 1993;86:189-193.
- Wu JJ, Sanchez-Palacios C, Brieva J, et al. A case of air bag dermatitis. Arch Dermatol. 2002;138:1383-1384.
- Vitello W, Kim M, Johnson RM, et al. Full-thickness burn to the hand from an automobile airbag. J Burn Care Rehabil. 1999;20:212-215.
- Centers for Disease Control and Prevention. Facts about sodium azide. Updated April 4, 2018. Accessed May 15, 2022. https://emergency.cdc.gov/agent/sodiumazide/basics/facts.asp
- Shepardson D. Honda to recall 1.2 million vehicles in North America to replace Takata airbags. March 12, 2019. Accessed March 22, 2022. https://www.reuters.com/article/us-honda-takata-recall/honda-to-recall-1-2-million-vehicles-in-north-america-to-replace-takata-airbags-idUSKBN1QT1C9
- Gabauer DJ, Gabler HC. The effects of airbags and seatbelts on occupant injury in longitudinal barrier crashes. J Safety Res. 2010;41:9-15.
- Rath AL, Jernigan MV, Stitzel JD, et al. The effects of depowered airbags on skin injuries in frontal automobile crashes. Plast Reconstr Surg. 2005;115:428-435.
Airbags are lifesaving during motor vehicle accidents (MVAs), but their deployment has been associated with skin issues such as irritant dermatitis1; lacerations2; abrasions3; and thermal, friction, and chemical burns.4-6 Ocular issues such as alkaline chemical keratitis7 and ocular alkali injuries8 also have been described.
Airbag deployment is triggered by rapid deceleration and impact, which ignite a sodium azide cartridge, causing the woven nylon bag to inflate with hydrocarbon gases.8 This leads to release of sodium hydroxide, sodium bicarbonate, and metallic oxides in an aerosolized form. If a tear in the meshwork of the airbag occurs, exposure to an even larger amount of powder containing caustic alkali chemicals can occur.8
We describe a patient who developed a bullous reaction to airbag contents after he was involved in an MVA in which the airbag deployed.
Case Report
A 35-year-old man with a history of type 2 diabetes mellitus and chronic hepatitis B presented to the dermatology clinic for an evaluation of new-onset blisters. The rash occurred 1 day after the patient was involved in an MVA in which he was exposed to the airbag’s contents after it burst. He had been evaluated twice in the emergency department for the skin eruption before being referred to dermatology. He noted the lesions were pruritic and painful. Prior treatments included silver sulfadiazine cream 1% and clobetasol cream 0.05%, though he discontinued using the latter because of burning with application. Physical examination revealed tense vesicles and bullae on an erythematous base on the right lower flank, forearms, and legs, with the exception of the lower right leg where a cast had been from a prior injury (Figure 1).
Two punch biopsies of the left arm were performed and sent for hematoxylin and eosin staining and direct immunofluorescence to rule out bullous diseases, such as bullous pemphigoid, linear IgA, and bullous lupus. Hematoxylin and eosin staining revealed extensive spongiosis with blister formation and a dense perivascular infiltrate in the superficial and mid dermis composed of lymphocytes with numerous scattered eosinophils (Figures 2 and 3). Direct immunofluorescence studies were negative. Treatment with oral prednisone and oral antihistamines was initiated.
At 10-day follow-up, the patient had a few residual bullae; most lesions were demonstrating various stages of healing (Figure 4). The patient’s cast had been removed, and there were no lesions in this previously covered area. At 6-week follow-up he had continued healing of the bullae and erosions as well as postinflammatory hyperpigmentation (Figure 5).
Comment
With the advent of airbags for safety purposes, these potentially lifesaving devices also have been known to cause injury.9 In 1998, the most commonly reported airbag injuries were ocular injuries.10 Cutaneous manifestations of airbag injury are less well known.11
Two cases of airbag deployment with skin blistering have been reported in the literature based on a PubMed search of articles indexed for MEDLINE using the terms airbag blistering or airbag bullae12,13; however, the blistering was described in the context of a burn. One case of the effects of airbag deployment residue highlights a patient arriving to the emergency department with erythema and blisters on the hands within 48 hours of airbag deployment in an MVA, and the treatment was standard burn therapy.12 Another case report described a patient with a second-degree burn with a 12-cm blister occurring on the radial side of the hand and distal forearm following an MVA and airbag deployment, which was treated conservatively.13 Cases of thermal burns, chemical burns, and irritant contact dermatitis after airbag deployment have been described in the literature.4-6,11,12,14,15 Our patient’s distal right lower leg was covered with a cast for osteomyelitis, and no blisters had developed in this area. It is likely that the transfer of airbag contents occurred during the process of unbuckling his seatbelt, which could explain the bullae that developed on the right flank. Per the Centers for Disease Control and Prevention, individuals should quickly remove clothing and wash their body with large amounts of soap and water following exposure to sodium azide.16
In 1989, the Federal Motor Vehicle Safety Standard No. 208 (occupant crash protection) became effective, stating all cars must have vehicle crash protection.12 Prior to 1993, it was reported that there had been no associated chemical injuries with airbag deployment. Subsequently, a 6-month retrospective study in 1993 showed that dermal injuries were found in connection with the presence of sodium hydroxide in automobile airbags.12 By 2004, it was known that airbags could cause chemical and thermal burns in addition to traumatic injuries from deployment.1 Since 2007, all motor vehicles have been required to have advanced airbags, which are engineered to sense the presence of passengers and determine if the airbag will deploy, and if so, how much to deploy to minimize airbag-related injury.3
The brand of car that our patient drove during the MVA is one with known airbag recalls due to safety defects; however, the year and actual model of the vehicle are not known, so specific information about the airbag in question is not available. It has been noted that some defective airbag inflators that were exposed to excess moisture during the manufacturing process could explode during deployment, causing shrapnel and airbag rupture, which has been linked to nearly 300 injuries worldwide.17
Conclusion
It is evident that the use of airbag devices reduces morbidity and mortality due to MVAs.9 It also had been reported that up to 96% of airbag-related injuries are relatively minor, which many would argue justifies their use.18 Furthermore, it has been reported that 99.8% of skin injuries following airbag deployment are minor.19 In the United States, it is mandated that every vehicle have functional airbags installed.8
This case highlights the potential for substantial airbag-induced skin reactions, specifically a bullous reaction, following airbag deployment. The persistent pruritus and lasting postinflammatory hyperpigmentation seen in this case were certainly worrisome for our patient. We also present this case to remind dermatology providers of possible treatment approaches to these skin reactions. Immediate cleansing of the affected areas of skin may help avoid such reactions.
Airbags are lifesaving during motor vehicle accidents (MVAs), but their deployment has been associated with skin issues such as irritant dermatitis1; lacerations2; abrasions3; and thermal, friction, and chemical burns.4-6 Ocular issues such as alkaline chemical keratitis7 and ocular alkali injuries8 also have been described.
Airbag deployment is triggered by rapid deceleration and impact, which ignite a sodium azide cartridge, causing the woven nylon bag to inflate with hydrocarbon gases.8 This leads to release of sodium hydroxide, sodium bicarbonate, and metallic oxides in an aerosolized form. If a tear in the meshwork of the airbag occurs, exposure to an even larger amount of powder containing caustic alkali chemicals can occur.8
We describe a patient who developed a bullous reaction to airbag contents after he was involved in an MVA in which the airbag deployed.
Case Report
A 35-year-old man with a history of type 2 diabetes mellitus and chronic hepatitis B presented to the dermatology clinic for an evaluation of new-onset blisters. The rash occurred 1 day after the patient was involved in an MVA in which he was exposed to the airbag’s contents after it burst. He had been evaluated twice in the emergency department for the skin eruption before being referred to dermatology. He noted the lesions were pruritic and painful. Prior treatments included silver sulfadiazine cream 1% and clobetasol cream 0.05%, though he discontinued using the latter because of burning with application. Physical examination revealed tense vesicles and bullae on an erythematous base on the right lower flank, forearms, and legs, with the exception of the lower right leg where a cast had been from a prior injury (Figure 1).
Two punch biopsies of the left arm were performed and sent for hematoxylin and eosin staining and direct immunofluorescence to rule out bullous diseases, such as bullous pemphigoid, linear IgA, and bullous lupus. Hematoxylin and eosin staining revealed extensive spongiosis with blister formation and a dense perivascular infiltrate in the superficial and mid dermis composed of lymphocytes with numerous scattered eosinophils (Figures 2 and 3). Direct immunofluorescence studies were negative. Treatment with oral prednisone and oral antihistamines was initiated.
At 10-day follow-up, the patient had a few residual bullae; most lesions were demonstrating various stages of healing (Figure 4). The patient’s cast had been removed, and there were no lesions in this previously covered area. At 6-week follow-up he had continued healing of the bullae and erosions as well as postinflammatory hyperpigmentation (Figure 5).
Comment
With the advent of airbags for safety purposes, these potentially lifesaving devices also have been known to cause injury.9 In 1998, the most commonly reported airbag injuries were ocular injuries.10 Cutaneous manifestations of airbag injury are less well known.11
Two cases of airbag deployment with skin blistering have been reported in the literature based on a PubMed search of articles indexed for MEDLINE using the terms airbag blistering or airbag bullae12,13; however, the blistering was described in the context of a burn. One case of the effects of airbag deployment residue highlights a patient arriving to the emergency department with erythema and blisters on the hands within 48 hours of airbag deployment in an MVA, and the treatment was standard burn therapy.12 Another case report described a patient with a second-degree burn with a 12-cm blister occurring on the radial side of the hand and distal forearm following an MVA and airbag deployment, which was treated conservatively.13 Cases of thermal burns, chemical burns, and irritant contact dermatitis after airbag deployment have been described in the literature.4-6,11,12,14,15 Our patient’s distal right lower leg was covered with a cast for osteomyelitis, and no blisters had developed in this area. It is likely that the transfer of airbag contents occurred during the process of unbuckling his seatbelt, which could explain the bullae that developed on the right flank. Per the Centers for Disease Control and Prevention, individuals should quickly remove clothing and wash their body with large amounts of soap and water following exposure to sodium azide.16
In 1989, the Federal Motor Vehicle Safety Standard No. 208 (occupant crash protection) became effective, stating all cars must have vehicle crash protection.12 Prior to 1993, it was reported that there had been no associated chemical injuries with airbag deployment. Subsequently, a 6-month retrospective study in 1993 showed that dermal injuries were found in connection with the presence of sodium hydroxide in automobile airbags.12 By 2004, it was known that airbags could cause chemical and thermal burns in addition to traumatic injuries from deployment.1 Since 2007, all motor vehicles have been required to have advanced airbags, which are engineered to sense the presence of passengers and determine if the airbag will deploy, and if so, how much to deploy to minimize airbag-related injury.3
The brand of car that our patient drove during the MVA is one with known airbag recalls due to safety defects; however, the year and actual model of the vehicle are not known, so specific information about the airbag in question is not available. It has been noted that some defective airbag inflators that were exposed to excess moisture during the manufacturing process could explode during deployment, causing shrapnel and airbag rupture, which has been linked to nearly 300 injuries worldwide.17
Conclusion
It is evident that the use of airbag devices reduces morbidity and mortality due to MVAs.9 It also had been reported that up to 96% of airbag-related injuries are relatively minor, which many would argue justifies their use.18 Furthermore, it has been reported that 99.8% of skin injuries following airbag deployment are minor.19 In the United States, it is mandated that every vehicle have functional airbags installed.8
This case highlights the potential for substantial airbag-induced skin reactions, specifically a bullous reaction, following airbag deployment. The persistent pruritus and lasting postinflammatory hyperpigmentation seen in this case were certainly worrisome for our patient. We also present this case to remind dermatology providers of possible treatment approaches to these skin reactions. Immediate cleansing of the affected areas of skin may help avoid such reactions.
- Corazza M, Trincone S, Zampino MR, et al. Air bags and the skin. Skinmed. 2004;3:256-258.
- Corazza M, Trincone S, Virgili A. Effects of airbag deployment: lesions, epidemiology, and management. Am J Clin Dermatol. 2004;5:295-300.
- Kuska TC. Air bag safety: an update. J Emerg Nurs. 2016;42:438-441.
- Ulrich D, Noah EM, Fuchs P, et al. Burn injuries caused by air bag deployment. Burns. 2001;27:196-199.
- Erpenbeck SP, Roy E, Ziembicki JA, et al. A systematic review on airbag-induced burns. J Burn Care Res. 2021;42:481-487.
- Skibba KEH, Cleveland CN, Bell DE. Airbag burns: an unfortunate consequence of motor vehicle safety. J Burn Care Res. 2021;42:71-73.
- Smally AJ, Binzer A, Dolin S, et al. Alkaline chemical keratitis: eye injury from airbags. Ann Emerg Med. 1992;21:1400-1402.
- Barnes SS, Wong W Jr, Affeldt JC. A case of severe airbag related ocular alkali injury. Hawaii J Med Public Health. 2012;71:229-231.
- Wallis LA, Greaves I. Injuries associated with airbag deployment. Emerg Med J. 2002;19:490-493.
- Mohamed AA, Banerjee A. Patterns of injury associated with automobile airbag use. Postgrad Med J. 1998;74:455-458.
- Foley E, Helm TN. Air bag injury and the dermatologist. Cutis. 2000;66:251-252.
- Swanson-Biearman B, Mrvos R, Dean BS, et al. Air bags: lifesaving with toxic potential? Am J Emerg Med. 1993;11:38-39.
- Roth T, Meredith P. Traumatic lesions caused by the “air-bag” system [in French]. Z Unfallchir Versicherungsmed. 1993;86:189-193.
- Wu JJ, Sanchez-Palacios C, Brieva J, et al. A case of air bag dermatitis. Arch Dermatol. 2002;138:1383-1384.
- Vitello W, Kim M, Johnson RM, et al. Full-thickness burn to the hand from an automobile airbag. J Burn Care Rehabil. 1999;20:212-215.
- Centers for Disease Control and Prevention. Facts about sodium azide. Updated April 4, 2018. Accessed May 15, 2022. https://emergency.cdc.gov/agent/sodiumazide/basics/facts.asp
- Shepardson D. Honda to recall 1.2 million vehicles in North America to replace Takata airbags. March 12, 2019. Accessed March 22, 2022. https://www.reuters.com/article/us-honda-takata-recall/honda-to-recall-1-2-million-vehicles-in-north-america-to-replace-takata-airbags-idUSKBN1QT1C9
- Gabauer DJ, Gabler HC. The effects of airbags and seatbelts on occupant injury in longitudinal barrier crashes. J Safety Res. 2010;41:9-15.
- Rath AL, Jernigan MV, Stitzel JD, et al. The effects of depowered airbags on skin injuries in frontal automobile crashes. Plast Reconstr Surg. 2005;115:428-435.
- Corazza M, Trincone S, Zampino MR, et al. Air bags and the skin. Skinmed. 2004;3:256-258.
- Corazza M, Trincone S, Virgili A. Effects of airbag deployment: lesions, epidemiology, and management. Am J Clin Dermatol. 2004;5:295-300.
- Kuska TC. Air bag safety: an update. J Emerg Nurs. 2016;42:438-441.
- Ulrich D, Noah EM, Fuchs P, et al. Burn injuries caused by air bag deployment. Burns. 2001;27:196-199.
- Erpenbeck SP, Roy E, Ziembicki JA, et al. A systematic review on airbag-induced burns. J Burn Care Res. 2021;42:481-487.
- Skibba KEH, Cleveland CN, Bell DE. Airbag burns: an unfortunate consequence of motor vehicle safety. J Burn Care Res. 2021;42:71-73.
- Smally AJ, Binzer A, Dolin S, et al. Alkaline chemical keratitis: eye injury from airbags. Ann Emerg Med. 1992;21:1400-1402.
- Barnes SS, Wong W Jr, Affeldt JC. A case of severe airbag related ocular alkali injury. Hawaii J Med Public Health. 2012;71:229-231.
- Wallis LA, Greaves I. Injuries associated with airbag deployment. Emerg Med J. 2002;19:490-493.
- Mohamed AA, Banerjee A. Patterns of injury associated with automobile airbag use. Postgrad Med J. 1998;74:455-458.
- Foley E, Helm TN. Air bag injury and the dermatologist. Cutis. 2000;66:251-252.
- Swanson-Biearman B, Mrvos R, Dean BS, et al. Air bags: lifesaving with toxic potential? Am J Emerg Med. 1993;11:38-39.
- Roth T, Meredith P. Traumatic lesions caused by the “air-bag” system [in French]. Z Unfallchir Versicherungsmed. 1993;86:189-193.
- Wu JJ, Sanchez-Palacios C, Brieva J, et al. A case of air bag dermatitis. Arch Dermatol. 2002;138:1383-1384.
- Vitello W, Kim M, Johnson RM, et al. Full-thickness burn to the hand from an automobile airbag. J Burn Care Rehabil. 1999;20:212-215.
- Centers for Disease Control and Prevention. Facts about sodium azide. Updated April 4, 2018. Accessed May 15, 2022. https://emergency.cdc.gov/agent/sodiumazide/basics/facts.asp
- Shepardson D. Honda to recall 1.2 million vehicles in North America to replace Takata airbags. March 12, 2019. Accessed March 22, 2022. https://www.reuters.com/article/us-honda-takata-recall/honda-to-recall-1-2-million-vehicles-in-north-america-to-replace-takata-airbags-idUSKBN1QT1C9
- Gabauer DJ, Gabler HC. The effects of airbags and seatbelts on occupant injury in longitudinal barrier crashes. J Safety Res. 2010;41:9-15.
- Rath AL, Jernigan MV, Stitzel JD, et al. The effects of depowered airbags on skin injuries in frontal automobile crashes. Plast Reconstr Surg. 2005;115:428-435.
Practice Points
- This case highlights the potential for a bullous reaction following airbag deployment.
- After airbag deployment, it is important to immediately cleanse the affected areas of skin with soap and water.
