Potassium hydroxide

The exact mechanism of action of KOH is not known but the speculated one is that topical application of KOH digests keratin, and induces inflammation.

The mechanism of skin injury by alkali substances such as potassium hydroxide is by the saponification of fat, causing fatty tissue to lose its function with increased damage due to a heat reaction. Extraction of water from cells occurs due to the hygroscopic (absorbent) nature of alkali. Dissolution of proteins also occurs, allowing for deeper penetration of OH- ions and resulting in various chemical reactions.

The alkali penetrates the skin quickly, saponifies plasma membranes, denatures collagen proteins, and leads to vascular thromboses in the conjunctiva and other parts of the eye. The resulting corneal burns include scarring and opacification of the cornea with resulting in vision loss, corneal neovascularization, ulcer formation, and perforation. Other consequences of untreated or very severe alkali burns include epithelial erosions, secondary glaucoma, and causes the destruction of conjunctival mucus cells, causing dry eyes, trichiasis (misdirected eyelash hairs), and other ocular conditions.

In the gastrointestinal tract, after oral ingestion, burns may result. The mechanism of injury is liquefactive necrosis. The thrombosis of gastrointestinal blood vessels also contributes to tissue damage. When the alkali enters the stomach, gastric acid may neutralize the strong base, which can limit the extent of the injury. Perforation of the stomach can sometimes occur with peritonitis and caustic injury to the surrounding organs including the colon, pancreas, liver, and spleen.