Abstract
Anti-adhesive sprays are commonly used in clinical practice to facilitate the removal of wound dressings. Despite their widespread use in hospital settings, the potential safety risks associated with these products have not been reported in the literature. We present the first documented case of a flame burn associated with the use of an anti-adhesive spray in a 32-year-old patient. This case highlights a previously unreported flammability hazard and underscores the importance of awareness when using aerosolised medical products in clinical environments.
Keywords: Anti-adhesive spray, Flame burn, Flammable aerosol, iatrogenic burn injury
Introduction
Although flame burn injuries are commonly associated with industrial or domestic accidents, it is uncommon to see them occur in medical settings. Reported causes include malfunction of medical equipment or vaping. However, no burn injury caused by a dressing change has previously been reported.
Medical dressings are a vital component of patient care, particularly in surgical settings.1 The choice of dressing depends on the wound’s type, depth, location, and severity. An ideal dressing should control moisture, allow gas exchange, manage excess exudate, protect the wound, be cost-effective, easy to change, and safe for the patient.2 In surgical care, anti-adhesive sprays are frequently used to facilitate easy removal and replacement of wound dressings. According to the manufacturer’s website, these sprays work by tracking between the adhesive and the skin, forming a silicone layer that weakens the adhesive bond without causing skin trauma. The spray evaporates quickly, allowing for immediate reapplication of new dressings without needing to clean the area first.3 As for the delivery system, there is no publicly available information. This discussion here is based on the assumption of a generic aerosol delivery system. Despite widespread use in public hospitals, no publications to date have examined the potential risks associated with these products. This article presents the first recorded case of a flame burn associated with the use of an anti-adhesive spray.
Case
A 32-year-old male presented to his local emergency department in April 2025 with a burn injury to the right buttock. He had a 3-year history of pilonidal abscess, for which he underwent multiple debridements and a local flap reconstruction. The surgical site had persistent dehiscence. His most recent debridement was 3 months prior, followed by a course of hyperbaric oxygen therapy that was completed 1 month before the incident. His wound care regimen consisted of an Inadine interface, a combined dressing, and Tegaderm film dressing.
His wife, a registered nurse, had been managing his dressings at home. A community nurse had provided anti-adhesive spray and instructed his wife to use it during dressing changes. On April 8, 2025, while removing the Tegaderm dressing, she sprayed the product and lifted the dressing from the edge- at which point a flame spontaneously ignited, catching the dressings on fire. She administered first aid and immediately brought the patient to the emergency department for burn care. It was noted that there were areas of partial-thickness burn with burst blisters, as seen in Figure 1.
Figure 1.
Initial presentation to the emergency department on the day of injury, demonstrating a burst blister and partial-thickness burn.
The burn was cleaned, debrided, and dressed by the regional Plastic Surgery Burn service with Acticoat 7. The burn was found to be <1% TBSA (total body surface area), with mixed superficial and superficial partial-thickness burns. One area, measuring 1 cm², was classified as a deep partial-thickness burn. The wound was further debrided in clinic and re-dressed with Acticoat 7 at the 1-week burn dressing review. It appeared to be clean and not infected, as seen in Figure 2. By day 21 post-injury, the wound was on the verge of being fully healed (as seen in Figure 3), though the patient reported localized hypersensitivity. He was advised to massage the area with moisturizer and provided with Mepilex Border dressings to protect the area from irritation caused by tight jeans. At his last plastic surgery clinic appointment, it was noted that his wound was largely healed, as seen in Figure 4. This particular brand of adhesive remover spray has been recalled from usage in our health service district, but the product is still available for sale.
Figure 2.
One week post-burn injury, showing a mixed superficial and superficial partial-thickness burn.
Figure 3.
Day 21 post-burn injury, demonstrating satisfactory wound healing progression.
Figure 4.
Five weeks post-burn injury, with the wound largely healed.
Discussion
According to the product website, all “no-sting” adhesive remover sprays are flammable.3 While manufacturers report a long history of safe use, combustion can occur if safety instructions are not followed or the product is misused. In general, aerosols (mist or spray), which are flammable, are often overlooked by legislators and academics.4 The use of chlorofluorocarbons has been replaced by flammable substances as a delivery system, such as hydrofluoroalkane.5 The Inadine dressing used in this case contains polyethylene glycol in its tulle base, which supports the sustained release of iodine.6 Polyethylene is a highly flammable material7 and has been reported to spontaneously ignite at temperatures as low as 70 °C. The patient also used a combined dressing, which is composed of flammable fleece and soft non-woven fabric. There are no articles published about Tegaderm causing static, but it is known that adhesion-peeling can convert mechanical energy into electrical energy (triboelectric),8 which may cause a spark. It is postulated that this combination of flammable dressing materials caught fire because of the energy generated during Tegaderm removal and was propagated by the accelerant properties of the adhesive remover spray.
Although the patient had previously undergone hyperbaric therapy, which has been associated with increased fire risk,9 this therapy had concluded a month before the incident and was unlikely to have contributed directly. Furthermore, there might be other unrecorded but well-known risks that can cause the incident, such as the use of alcohol-based prep or hand sanitizers before the removal of the dressing with the anti-adhesive spray.
The anti-adhesive spray and all dressings involved are commonly used in clinical settings. Therefore, caution should be exercised. Preventive measures include carefully reading warning labels before use and considering non-flammable alternatives where available. Further research is needed to develop safer dressing removal agents. Due to this incident, all users should also be warned against using it near an oxygen-rich source or in a poorly ventilated room.
Conclusion
This report presents the first documented case of a flame burn caused by an anti-adhesive spray. Users should exercise caution, familiarize themselves with product warnings, and consider non-flammable alternatives when possible.
Consent to participate
Informed consent has been obtained from the patient.
Funding
None.
Declaration of competing interest
No conflict of interest to declare.
References
- 1.Gu J., Dai X., Liu S., et al. Preparation of hydrophobic spray-coated spunlace nonwoven fabrics: possessing the potential for anti-adhesive medical dressings. Surfaces Interfaces. 2024;49 doi: 10.1016/j.surfin.2024.104366. [DOI] [Google Scholar]
- 2.Rezvani Ghomi E., Khalili S., Nouri Khorasani S., Esmaeely Neisiany R., Ramakrishna S. Wound dressings: current advances and future directions. J Appl Polym Sci. 2019;136(27) doi: 10.1002/app.47738. [DOI] [Google Scholar]
- 3.Esenta, The results you love now look better than ever. ESENTA, Silicone-based skin protection & adhesive removal. 2023. Accessed 5 May 2025. Available at: https://www.convatec.com/en-au/ostomy-care/guide-to-ostomy-products/accessories/esenta-with-ocl/
- 4.Yuan S., Ji C., Han H., Sun Y., Mashuga C.V. A review of aerosol flammability and explosion related incidents, standards, studies, and risk analysis. Process Saf Environ Prot. 2021;146:499–514. [Google Scholar]
- 5.Roche N., Usmani O., Franzini L., et al. Pharmaceutical, clinical, and regulatory challenges of reformulating pressurized metered-dose inhalers to reduce their environmental impact. J Aerosol Med Pulm Drug Deliv. 2025;38(1):26–36. doi: 10.1089/jamp.2024.0023. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Sibbald R.G., Elliott J.A. The role of Inadine in wound care: a consensus document. Int Wound J. 2017;14(2):316–321. doi: 10.1111/iwj.12602. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Salasinska K., Mizera K., Celiński M., Kozikowski P., Borucka M., Gajek A. Thermal properties and fire behavior of polyethylene with a mixture of copper phosphate and melamine phosphate as a novel flame retardant. Fire Saf J. 2020;115 doi: 10.1016/j.firesaf.2020.103137. [DOI] [Google Scholar]
- 8.Zhang L., Zhang Y., Li X., et al. Mechanism and regulation of peeling-electrification in adhesive interface. Nano Energy. 2022;95 doi: 10.1016/j.nanoen.2022.107011. [DOI] [Google Scholar]
- 9.Sheffield P., Desautels D. Hyperbaric and hypobaric chamber fires: a 73-year analysis. Undersea Hyper Med. 1997;24(3):153–164. [PubMed] [Google Scholar]