Garlic Burn: A Home Remedy Gone Wrong

Sir,

Skin acts as a barrier against external injurious stimuli including heat, friction, chemicals, etc., However, in many circumstances, patients land up to our clinic with self-inflicted injuries on the skin. We hereby report a case of an elderly lady with garlic paste induced chemical burn on the thigh.

A 60-year-old lady presented to the outpatient department with a painful ulcerative lesion on the right knee which started two days ago. She was a known case of advanced osteoarthritis of both knee joints for the last seven years, and she used to visit multiple physicians for her knee pain with moderate relief in symptoms. On being advised by one of the family members, the patient ground 10–12 cloves of garlic to a fine paste and applied the paste on the right knee joint at bedtime and covered it with a cotton cloth four days prior to consultation. The next morning, she noticed intense burning pain and discomfort in the area. Thereafter, there was the appearance of blisters which ruptured to attain the present status. There was no previous history of similar episodes. Cutaneous examination revealed a solitary circular large eroded plaque on the right knee (with overlying oozing and crusting). [Figure 1] Based on history and clinical findings, a diagnosis of “garlic burn” was done. She was prescribed oral antibiotics (amoxicillin and clavulanate), a short course of oral steroids for 5 days, and topical steroid-antibiotic combination cream and oral analgesics. She was advised to clean the area with isotonic normal saline twice a day.

Figure 1.

Solitary circular eroded and edematous plaque with overlying oozing and crusting. Note the surrounding bright red erythema extending beyond the plaque margin

Allium sativum (garlic) is recommended by naturopathic practitioners, for the treatment of numerous conditions.[1] It has been reported to possess antifungal, antiparasitic, antiviral, and antimicrobial properties. It is given either orally or topically. However, raw garlic in its fresh, crushed-clove form, is a potent irritant and it can lead to troublesome cutaneous adverse reactions. [2,3] It can lead to irritant contact dermatitis consistent with our case, and a delayed-type hypersensitivity reaction in previously sensitized individuals. It must be noted that in housewives and chefs with hand dermatitis, allergic contact dermatitis to garlic can occur and this is seen fairly common.[4] However irritant contact dermatitis to garlic leading to garlic burns has been reported infrequently.

Garlic burn was first described by Parish et al. in 1987.[5] Garlic burns may develop in other circumstances as well, including occupational dermatitis and factitious dermatitis. Occupational irritant contact dermatitis to garlic has been reported in housewives, cooks, food handlers, and Chinese janitors.[6] Factitial dermatitis due to garlic application, is a well-known ploy utilized by malingers. Kaplan et al. reported three Israeli soldiers who presented with erythematous, vesicular lesions on the lower limb leg, following the application of garlic.[7]

The implicated chemicals in these reactions are monosulfides, disulfides, and trisulfides; diallyl disulfide possessing the strongest sensitizing potential.[1] An oxidized derivative of diallyl disulfide, allicin, is also responsible for causing contact dermatitis. The components induce acantholysis, leading to blister formation followed by necrosis and sloughing of skin. Allicin dysregulates the metabolism of cysteine-containing proteins, leading to disruption of the keratinocytes and intercellular junctions, eventually causing coagulative necrosis.[1]

The degree of burn is directly proportional to the quantity of garlic, duration of exposure, the presence of pre-existing dermatoses, and sensitivity of skin. Infants, with thinner stratum corneum are more vulnerable to develop these reactions. The contact time required by the skin to undergo necrotic changes is usually 6–8 h in infants, unlike adults who need 10–12 h to manifest with symptoms of blistering and irritation.[3] Application of garlic under occlusion, leads to severe irritation and allergic reactions, because of the increased concentration and percolation of the sensitizing compounds into the skin.[8]

Treatment involves the application of anti-inflammatory agents like topical corticosteroids, with oral antibiotics if there is a superadded bacterial infection. Severe reactions often need to be managed by oral corticosteroids. Resolution is usually noted within 2 weeks. We would like to discourage the use of garlic (in a paste or any other topical formulation) as a home remedy, due to the lack of evidence in favor of effectiveness, apart from the propensity to cause contact dermatitis, as manifested in our patient.

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Conflicts of interest

There are no conflicts of interest.