The Biochemistry of Acid Assault Wounds
An exploration of the biochemical mechanisms that take place in our bodies as our skin comes in contact with corrosive substances
Theme: Health Issues and Disease / Ethics and Controversy
Disclaimer: The following publication from Under the Microscope contains material that may be disturbing to some readers. This article only aims to educate and inform readers about the essential aspects of vitriolage and is provided in good faith. If you think the contents of this article might pose risks to you, please do not read any further.
I knew very little about vitriolage; growing up, I somehow remained unknown to the bitter reality behind acid assaults and the fact that a person could even sustain the thought of effectuating such an unpardonable offence that can damage someone’s life. It was not until 2013 that I came across the details behind this heinous crime when television channels and newspapers were flooded with reports of increasing acid assaults in the UK. The most commonly used substances for these assaults are Hydrofluoric Acid (HF), Hydrochloric Acid (HCl), Sulfuric Acid (H2SO4) and Nitric Acid (HNO3). In places where the sale of acids is more controlled, attackers use other corrosive substances like Sodium Hydroxide (NaOH), which is alkaline.
Although attackers intend to mortify the victims rather than kill them, the medical and psychological effects of acid assaults are perpetual in a survivor’s life. Common reasonings as to what prompts an offender to use this mutilating form of violence include, but are not limited to vengeance for refusal of sexual advances, marriage proposals and demands for dowry, jealousy and lust, anti-minority discrimination, racial discrimination, conflicts over land ownership, and many more. The Acid Survivors Trust International, a London-based charity, informed that although 80% of acid attacks are on women, the gender ratio of victims and perpetrators is difficult to establish as acid attacks are either underreported or not recorded at all by authorities. Whilst there are relatively fewer cases nowadays, the true scale of acid assaults is unknown as police worldwide have also expressed that sufferers are often hesitant to report these incidents. With South Asian countries having the highest rates of acid attacks, it is believed that these assaults are heavily gendered and driven by the mentality “If I can’t have you, no one can.” This article hopes to introduce you to the scientific mechanisms that take place in the skin after acid is thrown, and how you can help if you are a witness to an acid assault.
I would first like to start by explaining some of the basic chemistry concepts that are fundamental to understanding the complex mechanisms of acid assaults. Taking Hydrochloric Acid (HCl) as an example: The compound hydrogen chloride consists of the chemical elements Hydrogen and Chlorine. The atomic structures of the elements hydrogen and chlorine contain a nucleus in the centre, which is home to protons and neutrons, with shells around the nucleus and electrons orbiting around the nucleus in these shells. The diagram below may help you visualise this.
Both hydrogen and chlorine are diatomic gases at room temperature and pressure, meaning that in standard conditions, their natural state exists as a molecule containing two atoms of the same element. In our case, H2 and Cl2 (H-H and Cl-Cl). As both of these are in gaseous states, they experience a force of attraction which causes them to combine and form a polar covalent bond, where one atom of H from H-H and one atom of Cl from Cl-Cl are sharing a pair of electrons - this marks the creation of gaseous HCl. As the covalent bond is polar, bubbling gaseous HCl in water will cause the atoms to dissociate into their respective ions; the hydrogen atom ionises into a H+ ion and the chlorine atom ionises into a Cl- ion. The nature of the elements H and Cl allows them to be readily dissociated into their ions and this full dissociation classifies HCl as a strong acid. Now taking Sodium Hydroxide (NaOH) as an example: although NaOH is basic, the concept is no different. When in solution, the sodium ion (Na+) and the hydroxide ion (OH-) form. Again, it is the complete dissociation of the compound which makes it a strong acid or a strong base.
When an acid, such as hydrofluoric acid, is thrown, it penetrates the skin and dissociates into its respective ions - the Hydrogen ion (H+) and the Fluoride ion (F-). The disruption of the skin begins as soon as the fluoride ion comes in contact with the skin tissues because it has a strong affinity for calcium ions (Ca2+) which are readily available in our tissues and bones. This affinity causes the fluoride ions to bind to calcium ions, resulting in cardiac arrhythmias and hypocalcaemia, often classed as the causes of death after an acid assault. The powerful nature of the F- is also responsible for a process called liquefaction necrosis which causes tissues in our skin to turn into a viscous liquid. This is followed by coagulation necrosis, which highly restricts blood flow to the skin tissues and causes sudden cell deaths. Certain enzymes in our skin are constantly working on rejuvenation, which includes the removal of dead skin cells and restoring them with new ones. In the event of vitriolage, the extremely low pH when strong acids are used or the extremely high pH when strong alkalis are used denatures these enzymes in our skin. As the enzymes are denatured, they lose their perfect shape and the ability to function. This in turn prevents proteolysis, which is the process of breaking down and removing unnecessary proteins from various parts of the body. Due to coagulation necrosis causing sudden cell deaths and the denaturation of enzymes, fragments of dysfunctional proteins are left behind and the absence of proteolysis causes a buildup of such functionally impaired proteins. As a result, the skin is unable to recycle the amino acids from the malfunctioning proteins or create new ones, explaining why acid assault causes the skin to be completely disfigured.
If you are a witness to acid attacks anytime in the future, be sure to follow these steps:
Report the crime immediately.
Wear gloves before you help the casualty. This prevents you from becoming a secondary casualty, as well as prevents the spread of germs to the casualty’s wounds.
Swiftly but carefully remove contaminated clothing and jewellery from the casualty’s body, or carefully cut away clothing.
If the chemical is a dry powder, carefully brush it off the skin.
Rinse the wounded skin under superabundant amounts of running water which is not contaminated. Use clean drinking water and pour on the skin if running water is not available. Water helps to neutralize the corrosive substance.
Use water ONLY. Using other liquids might not neutralise the corrosive agent.
Give priority to the eyes, face and airway when rinsing the wounded skin if there are multiple burns.
Do not wipe the skin. This could spread contamination and could be fatal to the victim as they are more prone to infections now than they were ever.
Continue to run water through the wounds until medical help/ambulance arrives.
I realised how pressing the issue of acid assaults is when I discovered Laxmi Agarwal’s story. Laxmi was attacked by three men in New Delhi when she was 16, for declining romantic overtures from a paedophilic, eccentric individual, known to be Naeem Khan. Watching a biographical drama based on her life gave me an understanding of how challenging it must have been for her to come to terms with the aftermath of the attack. Throughout the movie, some scenes were particularly distressing; in one of the scenes, a child screams in fear after he sees the blighted face of the victim. In another scene, a mother covers her daughter’s eyes and tells her not to look at the victim. Why?
We place so much worth on beauty. Makeup and beauty appliances are, to some extent, made to enhance our appearance. Sometimes when I scroll down my Instagram search feed, I see models posing with flawless, glass-like, spotless skin when in reality, blemishes and breakouts are prevalent. The fashion industry’s productions are unmistakably made to uplift our confidence, but I feel that sometimes it forgets that there are women, like Laxmi, who have been through torture and abuse - such as survivors of acid assaults, sexual assaults and trafficking. It forgets that every scar on their skin is beautiful too. How often do you see acid assault survivors modelling for A-List brands? Or do you see them modelling at all?
Sufferers of vitriolage will continue to see themselves as ghostly creatures until we try to instil the concept that their scars need not be hidden - their scars are symbols of the courage with which they fought against perpetrators and survived hell.
Vitriolage: A formal term used to describe acid throwing
Alkaline: Having a pH value that exceeds 7
Compound: A substance formed from two or more elements
Chemical elements: A substance that cannot be broken down any further by chemical means and are the primary constituents of matter
Atomic structures: The smallest and simplest form of elements that can exist
Protons: A subatomic particle with a positive charge
Neutrons: A subatomic particle without a charge
Electrons: A subatomic particle with a negative charge
Polar covalent bond: A type of covalent bond where the sharing of electrons is unequal. Because of this, one end of the molecule has a slight positive charge and the other end has a slightly negative charge
Dissociate: When a compound or molecule splits into smaller atoms or ions
Ions: An electrically charged atom caused by the gain or loss of one or more electrons
Affinity: The degree to which a substance tends to combine with another
Cardiac arrhythmia: A set of conditions that cause the heart to beat irregularly
Hypocalcaemia: A condition in which the body has lower than normal levels of calcium in the blood plasma
Viscous: Thick and clinging
Enzymes: Biological molecules that speed up chemical reactions in cells
pH: The measure of how alkaline or acidic a substance is
Jones, C. (6 November 2018). Inside the Hospital Treating Acid Attack Scars). BBC News. Retrieved 12 October 2020. [Online] Available from: <https://www.bbc.com/news/health-46044634>
BD Editors. (6 August 2017). Proteolysis. Biology Dictionary. Retrieved 12 October 2020. [Online] Available from: <https://biologydictionary.net/proteolysis/>
Burd, A. (6 September 2019). Acid Attacks: Part 1. The PMFA Journal. Retrieved 12 October 2020. [Online] Available from: <https://www.thepmfajournal.com/features/post/acid-attacks-part-1>
Baig, J. (12 August 2017). Exactly What to Do in an Acid Attack. VICE. Retrieved 12 October 2020. [Online] Available from: <https://www.vice.com/en/article/qvvpyq/exactly-what-to-do-in-an-acid-attack>
Forster, K. (14 July 2017). Acid Attack First Aid: What You Need To Do Immediately To Help Victims. The Independent. Retrieved 12 October 2020. [Online] Available from: <https://www.independent.co.uk/news/uk/home-news/acid-attack-first-aid-guide-what-need-do-help-victim-st-johns-ambulance-water-a7841476.html>
Sandhu, S. (31 August 2017). What To Do In The Event Of An Acid Attack, According To The NHS. iNews UK. Retrieved 12 October 2020. [Online] Available from: <https://inews.co.uk/news/health/nhs-says-event-acid-attack-88068>