Garlic Burn: A Home Remedy Gone Wrong

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634 © 2021 Indian Dermatology Online Journal | Published by Wolters Kluwer - Medknow
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‑inicted 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ne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 ndings, 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
Garlic Burn: A Home Remedy Gone Wrong
Letter to the Editor
analgesics.Shewasadvised tocleantheareawith isotonic
normalsalinetwiceaday.
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 rst 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
monosuldes, disuldes, and trisuldes; diallyl disulde
possessingthestrongestsensitizingpotential.[1]Anoxidized
derivative of diallyl disulde, 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‑inammatory
agents like topical corticosteroids, with oral antibiotics if
Figure 1: Solitary circular eroded and edematous plaque with overlying
oozing and crusting. Note the surrounding bright red erythema extending
beyond the plaque margin
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Letter to the Editor
635Indian Dermatology Online Journal | Volume 12 | Issue 4 | July-August 2021
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 eectiveness, apart from the
propensitytocausecontactdermatitis, asmanifestedin our
patient.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and
otherclinical informationtobereportedinthejournal.The
patients understand that their names and initials will not
bepublishedanddueeortswillbemadeto conceal their
identity,butanonymitycannotbeguaranteed.
Financial support and sponsorship
Nil.
Conicts of interest
Thereare noconictsof interest.
Bhushan Madke, Anupam Das1
Department of Dermatology, Jawahar Lal Nehru Medical College
and Datta Meghe Institute of Medical Sciences, Sawangi, Wardha,
Maharashtra, 1Department of Dermatology, KPC Medical College and
Hospital, Kolkata, West Bengal, India
Address for correspondence:
Dr. Anupam Das,
Department of Dermatology, KPC Medical College and Hospital,
Kolkata, West Bengal, India.
E‑mail: anupamdasdr@gmail.com
References
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7. KaplanK, SchewachM,YoravS. Factitialdermatitisinducedby
applicationof garlic.Int JDermatol1990;29:75‑6.
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How to cite this article: Madke B, Das A. Garlic burn: A home remedy
gone wrong. Indian Dermatol Online J 2021;12:634‑5.
Received: 06-Aug-2020. Revised: 16-Aug-2020.
Accepted: 01-Oct-2020. Published: 20-Jun-2021
© 2021 Indian Dermatology Online Journal | Published by Wolters Kluwer - Medknow
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