Necrotizing fasciitis and gangrene associated with topical herbs in an infant.

Department of Paediatrics, Plastic and Reconstructive Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Advances in Therapy (Impact Factor: 2.44). 24(4):921-5. DOI: 10.1007/BF02849985
Source: PubMed

ABSTRACT A 4-mo-old Chinese infant developed necrotizing fasciitis and gangrene from a small skin infection on his buttock that was treated with topical herbs. Sequential cultures revealed a number of organisms: Enterococcus species, sensitive to ampicillin, were isolated throughout the course, and coagulasenegative staphylococci replaced gram-negative rods during the later phase of the illness. The infant required prolonged intravenous antibiotic treatment and underwent multiple surgical procedures for debridement and reconstruction. This report serves to alert the public of the importance of avoiding application of unknown topical herbs in children with skin disease. A seemingly small wound, if inappropriately treated, may result in extensive tissue destruction and require extensive surgery.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Necrotising fasciitis can be life threatening, requiring prompt diagnosis and surgical debridement. We report a case of necrotising fasciitis caused by an adulterate traditional Asian medication--Jamu Pegal Linu, containing toxic levels of phenylbutazone and dipyrone. The patient presented with severe neutropenia and sepsis. An urgent extensive debridement was carried out (within 6 hours of presentation). Repeated debridements were performed on days 2 and 5, augmented with antibiotics and granulocyte colony-stimulating factor.
    Journal of orthopaedic surgery (Hong Kong) 09/2009; 17(2):223-6.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Many parents purchase topical applications without knowing what they contain, and apply them liberally to their children with dermatological disorders. In one such case, an infant developed fever, diarrhea and a small ulcer near the right labia majora which was treated with a topical cream called '999' containing dexamethasone acetate. The infant subsequently developed extensive necrotizing fasciitis. She required prolonged intravenous antibiotic use and underwent multiple surgical procedures for debridement and reconstruction. Another mother was concerned about therapeutic corticosteroids prescribed to her 11-year old daughter with eczema. She acquired the 999 cream from the Chinese mainland and applied it liberally as an emollient to her daughter's back. When assessed at the clinic, her daughter appeared cushingoid with accelerated growth velocity in BMI and weight but decelerated growth in height. Furthermore, one mother applied a large quantity of 999 on her daughter with mild eczema and another mother applied it on her son with impetigo. None of these mothers knew that they were using potent topical corticosteroids. This report serves to alert the public to avoid applying unknown topical medication on children with skin diseases. The physician caring for patients with skin disease should be aware that even steroidophobic parents might indeed be unknowingly using potent corticosteroids.
    Journal of Dermatological Treatment 01/2008; 19(4):241-5. · 1.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Integrative medicine is a relatively new discipline which attempts to combine allopathic medicine with alternative or complementary medicine, to reap the benefits of both forms of medicine in optimizing the care of patients. Integrative medicine concentrates on treating the patient as a whole, both in body and mind. While the scientific method and "evidence-based" clinical research drives the management and treatment of diseases in conventional Western medicine, alternative or complementary medicine is based on unproven yet potentially beneficial techniques that have been developed throughout history, dating back to the ancient cultures in the Middle East, Africa, and China. In spite of the lack of evidence of most alternative medicine techniques, these methodologies have been practiced for centuries with great acceptance in many countries. It is in the Western world, where "modern" medicine is dictated by the scientific method, that the most controversy in the use of these alternative modes of therapy exists. Since the science behind alternative medicine is incomplete or non-existent, it is difficult for those trained in Western medicine to accept or adopt this approach. But perhaps it is the failure of Western medicine to adequately guarantee our well being and good health that have led to the ongoing debate between the medical profession and the general public as to the benefits of these alternative treatments. In one sense, integrative medicine may be a futile attempt to coin a new term in the hope of legitimizing alternative medicine. On the other hand, there is a wealth of historical experience in the use of the techniques. Studies to evaluate the scientific basis behind ancient medical techniques are ongoing, and it is to be expected that the results will neither be uniformly positive nor negative. Of particular interest is the effect of traditional medicine, herbal formulations, and manipulative techniques on the immune system, and its application in the treatment of autoimmune and allergic diseases. Studies are being designed or conducted to investigate immune effects of herbal formulations or their components. Herbal plants or medicines may lead to skewing of the Th1/Th2 balance in either direction, thus may offer potential application in the treatment of allergic or autoimmune diseases.
    Clinical Reviews in Allergy & Immunology 06/2012; · 5.59 Impact Factor