Burn is among the important challenges for medicine which can cause irremediable physical and mental damage and eventually death. Due to the damage inflicted on the body’s defense barrier (the skin), which renders it susceptible to external factors, infection of the burn wound is among the important challenges the victim has to face. The grading of a burn is done according to the depth of the necrosis occurring in skin tissue.
In 1st degree burns, the damage is limited to the epidermis. In 2nd degree burns, the depth of the burn has expanded to the dermis, but the fat layer under the skin is intact. 2nd degree burn is itself divided into two categories: superficial and deep. The main characteristic of superficial 2nd degree burn is the formation of blisters and accumulation of liquid between the epidermis and dermis, which usually occurs several hours after the incident. In deep 2nd degree burn, necrosis occurs in deep layers of the dermis; due to the complete loss of the dermis; this type of burn results in severe scarring. In 3rd degree burns, the necrosis goes beyond the dermis and affects the fat layer under the skin. In 4th degree burn, the necrosis goes deeper and affects tissues under the skin, like muscle and bone tissues.
The stages of healing include hemostasis, inflammation, proliferation and reformation. Aloe has shown in vitro inhibition of thromboxane. The enzymes present in aloe disintegrate the damaged tissue and these tissues are scavenged through phagocytosis. In an in vitro study, a glycoprotein phytoconstituent of aloe has shown to increase the proliferation of the keratinocytes and the expression of receptors of Epidermal Growth Factor (EGF) and fibronectin. It was later demonstrated that this glycoprotein accelerates wound healing in vivo by increasing proliferation. Beta-sitosterol accelerates wound-healing in vivo, through stimulation of angiogenesis and neovascularization. Also, Aloe vera advances healing in vivo and reduces inflammation in 2nd degree burn.
In a study on 72 patients with burns with relative thickness, in comparison to a control group that used vaseline gauze, topical use of Aloe vera gel significantly accelerated wound healing. The average healing time in aloe gel group was 11.89 days, while this time was 18.18 days for the control group. After 14 days, complete epithelialization had occurred in the Aloe vera group.
In a survey conducted on 18 out-patients with 2-12 percent 2nd degree superficial and deep burns, Aloe vera ointment showed to be effective against bacterial colonization and was as effective as Silver Sulfadiazine (SSD) with regard to time of healing. The average healing time was reported to be 13 days with Aloe vera and 15-16 days with SSD. In vitro, Aloe vera has shown to be effective against a broad spectrum of bacteria including Pseudomonas aeruginosa, Streptococcus pyogenes and Staphylococcus aureus.(3,8)
Numerous in vitro findings show that lavender essential oil has antibacterial and antifungal activities. Also, it has been demonstrated that lavender essential oil is effective upon gram-negative bacteria and agreeably covers Pseudomonas species. Local administration of lavender essential oil has rubefacient effects, and seems to have analgesic, anti-allergic and anti-inflammatory effects.
Rose geranium essential oil is antidepressant and disinfectant, a valuable astringent and hemostatic agent. These characteristics cause rapid wound healing and make it very beneficial as a wound-healing agent. Furthermore, E-coli, the golden Staph and Pseudomonas aeruginosa are among the important species that geranium is effective against.
In a random double-blind clinical trial, 111 patients with superficial 2nd degree burns used either Lagex burn cream or SSD 1% cream once a day, for two weeks. For each patient, after cautious debridement and cleansing of the wound caused by burn using a suitable antimicrobial solution (Chlorhexidine 0.35%), 5 grams of cream per 10 centimeters of burn area was applied using sterile spatula. Then the wound was dressed with sterile gauze and bandaged. The treatment continued as once a day until the complete healing of the wound. The patients were evaluated for pain, itching and burn, before the commencement of the treatment, the first 24 hours, 48 hours, the first week and two weeks after. Based on the results of this survey, Lagex burn cream was significantly more effective than SSD as evaluated in the different intervals with regards to pain and burn sensation. There was no significant difference between the groups in terms of itching (p>0.1). Among the studied individuals, only one had infection in the Lagex group (0.9%), who was healed with continued treatment. The degree of dryness in wound area was significantly lower in the second day in the Lagex group in comparison to the SSD group. The degree of thorough healing in the two groups was 90.9% after 7 days and 100% after 14 days, and there was no statistically significant difference between the two groups (p=0.52). The researchers came to the conclusion that, considering the adverse effects of SSD in relative inhibition of epithelialization and so leaving of black marks in the wound area, Lagex burn cream can, along with decrease in pain and dryness in the burn area, be a reasonable substitute for SSD in prevention of infection as well.