CHEMICAL burns are considered the most severe and complex type of burn injury, combining the destructive effects of both chemical reactions and thermal damage.
Unlike traditional flame burns, where the source of injury is quickly removed, chemical agents such as acids or alkalis can remain active on the skin for weeks even months continuing to harm the body long after the initial contact.
This lingering nature of the chemical makes treatment more difficult and significantly delays the healing and reconstruction process.
Avisena Consultant Plastic and Reconstructive Surgeon, Dr Wan Syazli Rodzaian Wan Ahmad, emphasised that chemical burns involve “two injuries in one”, a chemical reaction that eats away at tissue and a heat burn caused by the reaction itself.
“The worst thing about chemical burns is that the chemical agent can remain on the skin for quite some time, sometimes two weeks, three weeks, even up to a month or two.
“When someone suffers a chemical burn, the agent doesn’t just disappear. It stays on the skin, continuing to cause damage if not properly treated,” he said during an interview at Avisena Women’s & Children’s Specialist Hospital.
He added that while burns caused by heat alone can be dressed and prepared for reconstruction fairly quickly, chemical burns present ongoing risks due to the agent's continued activity on the skin.
Dr Wan Syazli stated that if a graft is placed too early, the chemical may still be present, causing the new skin to fail and forcing the entire process to start again.
In cases like national footballer Faisal Halim, who suffered fourth-degree burns in an acid attack, Dr Wan Syazli stated that speed and precision were crucial.
Due to the nature of the injury, artificial skin substitutes, often created in laboratories, could not be used.
Instead, Faisal was treated with real human skin sourced from a skin bank in Belgium, currently the only global supplier.
Although delivery typically takes two weeks, urgent coordination meant the skin arrived in Malaysia in just two days. Dr Wan Syazli revealed that Malaysia’s Health Ministry is currently working to establish a national skin bank to improve future treatment capabilities.
He further pointed out that modern burn treatment has moved away from traditional daily dressings, which can extend over months and take a psychological toll on patients.
There has been a shift towards newer technologies, including stem cell therapy, bioregulators, and specially formulated serums that help stimulate natural skin regeneration. In smaller or less severe wounds, these treatments may allow the skin to heal without the need for surgical grafting.
“If there’s a burn on the leg, you can use growth factors combined with stem cells to stimulate the body to produce new skin.
“Eventually, with this method, the skin can close on its own without the need for grafting.
“However, there are certain cases where this technology isn’t suitable, for instance, if the wound is too large and there isn’t enough time to wait for the skin to regenerate,” he said.
He added extensive burns where large areas of the body are affected, these advanced methods might not be fast enough.
Dr Wan Syazli highlighted that prolonged exposure increases the risk of complications such as infection or critical water loss.
In such situations, doctors must resort to skin coverage procedures.
He emphasised that treatment strategy depends on multiple factors, size of the wound, availability of donor skin, and which part of the body is affected.
For instance, burns on the palm or elbow require different approaches compared to the chest or thigh due to varying skin thickness and mobility concerns.
“If the burn area on the hand palm compared to the burn area on the chest is different because the skin quality is different,” he said.
In high-mobility areas, like joints, scarring can significantly affect function. In these cases, priority is given to grafting those areas to preserve movement.
Dr Wan Syazli stated that when skin is required for grafting, the scalp is the preferred source due to its ability to heal quickly without visible scarring. After two weeks, skin can even be harvested from the same area again.
In cases where skin is limited, even a small 1 cm² sample can be cultured in a lab to produce more tissue for grafting.
He also addressed a common question from families of burn patients whether skin can be donated by relatives. He stressed that skin grafts can only be taken from the patient themselves, as donated skin from others would be rejected unless it is specifically treated and sourced from certified skin banks.
“You can only use your own skin,” he added.
Treating severe chemical burns, he said, is not just about medical expertise but also about careful planning, team coordination, and patient mental strength.
Cases like Faisal’s highlight how far burn treatment has advanced, but also underline the importance of early intervention, proper resources, and long-term rehabilitation for full recovery.
Following the acid attack on May 5, 2024, Faisal sustained fourth-degree chemical burns. He spent 10 days in the ICU and a total of three weeks in hospital, where he underwent multiple surgeries.
The 27-year-old winger, nicknamed “Mickey,” was attacked with acid by an unknown individual outside a shopping mall in Petaling Jaya. Despite extensive investigations, police have yet to identify a suspect.
On May 8, 2025, Faisal’s legal team revealed that the Attorney-General’s Chambers had classified the case as “No Further Action” (NFA).
Although the case remains open, police confirmed there are no new leads at this time. The AGC noted that the decision could be revisited should new evidence come to light.
Faisal, a key figure for both the national team and Selangor, captured national attention when his equaliser against South Korea was voted the best goal of the 2024 Asian Cup.