Featured Case

  • Abstract

    A 63-year-old male patient presented with a burn wound at the anteromedial aspect of the right leg with a history of accidental spilling of boiling hot water before 2 days. The patient applied toothpaste at the site immediately after the burn and the entire skin got peeled off. The presenting complaints were completely peeled off skin with redness, pain and burning sensation at the burn site. There was no formation of blisters. The patient approached Dr Sateesh varier who made the biomedical diagnosis as superficial second-degree burn based on the clinical presentation and examination. The ayurvedic diagnosis was Shuddha vrana and the line of treatment adopted was Vrana ropana. The redness disappeared and healthy skin re-growth started within 1 week of treatment. After 2 weeks of treatment, the wound completely healed without any scar. In a further follow-up after 2 weeks, the skin regained its normal colour.

  • Summaries

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      Second degree burn (superficial)
      Shuddha vrana

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      A 63-year-old male patient presented with a burn wound at the anteromedial aspect of the right leg with a history of accidental spilling of boiling hot water before 2 days. The patient applied toothpaste at the site immediately after the burn and the entire skin got peeled off. The presenting complaints were completely peeled off skin with redness, pain and burning sensation at the burn site. There was no formation of blisters. The patient approached Dr Sateesh varier who made the biomedical diagnosis as superficial second-degree burn based on the clinical presentation and examination. The ayurvedic diagnosis was Shuddha vrana and the line of treatment adopted was Vrana ropana. The redness disappeared and healthy skin re-growth started within 1 week of treatment. After 2 weeks of treatment, the wound completely healed without any scar. In a further follow-up after 2 weeks, the skin regained its normal colour.

  • Timeline

  • Tabulated Summary

  • Narrative

    TITLE OF CASE

    Successful standalone ayurvedic management of Second degree burn - A case report

    Dr Satheesh S Warrier

    ABSTRACT

    A 63-year-old male patient presented with a burn wound at the anteromedial aspect of the right leg with a history of accidental spilling of boiling hot water before 2 days. The patient applied toothpaste at the site of burn immediately  and the entire skin got peeled off. The presenting complaints were completely peeled off skin with redness, pain and burning sensation at the burn site. There was no formation of blisters. The patient approached Dr Sateesh varier who made the biomedical diagnosis as superficial second-degree burn based on the clinical presentation and examination. The ayurvedic diagnosis was Shuddha vrana and the line of treatment adopted was Vrana ropana. The redness disappeared and healthy skin re-growth started within 1 week of treatment. After 2 weeks of treatment, the wound completely healed without any scar. In a further follow-up after 2 weeks, the skin regained its normal colour.

    KEYWORDS

    Second degree burn, case report, shudha vrana, standalone

    INTRODUCTION

    A burn is damage to your body's tissues caused by heat, chemicals, electricity, sunlight or radiation.

    There are three types of burns:

    • First-degree- The burn is limited to only the outer layer of skin

    • Second-degree- The burn affects the outer layer and the layer underneath

    • Third-degree- The burns damage or destroy the deepest layer of skin and tissues underneath. [1]

    Diagnostic criteria: A diagnosis is usually formed based on depth of the burn. The extent/intensity of a burn is generally based on the "rule of nines."

    Treatment: Treatment decisions are based on the need to relieve pain, reduce swelling, prevent infection, and promote healing. The cause of burn- thermal, chemical, electrical or radiation is also an important factor in deciding the treatment plan.

    PATIENT INFORMATION

    A 63-year-old male patient presented with a burn wound at the anteromedial aspect of the right leg with a history of accidental spilling of boiling hot water before 2 days.

    Medical History: He applied toothpaste immediately at the site of the burn, and the skin peeled off completely. There was no other previous consultation. He approached Dr Sateesh after 2 days of the onset of symptoms.

    CLINICAL FINDINGS/PHYSICAL EXAMINATION

    On physical examination, completely peeled-off skin with redness at the burn site, and no blisters were noted.

    Image 1. Baseline Image added below

    TIMELINE

    Image 2. TIMELINE of events added below

    DIAGNOSTIC ASSESSMENT

    Modern Diagnostic parameter: Based on the physical examination and history taking, the biomedical diagnosis was made by Dr Satheesh S Warrier as Second-degree burn.

    Ayurvedic Assessment was done based on the investigation reports and the clinical evaluation by the ayurvedic physician.

    Differential Diagnosis- The diagnosis was confirmed with clinical examination and evaluation..

    Prognosis- The outcomes of burn patients depend on the degree and extent of the burn. Most second and third-degree burns require prolonged admission and recovery is slow. Healing typically occurs within 3 weeks with minimal scarring. In this case, with 2 weeks of standalone Ayurvedic treatment, the burn wound healed completely.

    THERAPEUTIC INTERVENTION

    See the tab ‘Treatment details’

    FOLLOW-UP AND OUTCOMES

    Clinician-based assessment; A follow-up after 6 days (21.1.2022), redness disappeared, and healthy skin regrowth had started. After another 10 days (1.2.2022), the wound was completely healed with no scar. Follow up done on 20.2.2022 revealed a near normal skin tone at the site of the burn.

    1. Not relevant.

    Image 3. During treatment image added below

    Image 4. After treatment image added below

    Image 5. Follow up image added below

    Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well.

    Method of assessment- By monitoring the patient.

    Adverse and unanticipated events; None reported.

    DISCUSSION ;

    In this patient, pain and a burning sensation were the main symptoms. The case was treated as Shudha Vrana. Grita is best for vrana ropana, and Mahathikthakam is having an effect on daha.

    PATIENT’S PERSPECTIVE

    Not available.

    LEARNING POINTS/TAKE-HOME MESSAGES

    The case report illustrates the utility of ayurveda concepts and the efficacy of ayurvedic medicines in treating second degree burn, that helps healing of the wound without retaining the scar.

    INFORMED CONSENT

    Written consent was obtained from the patient to publish the case report.

    CONFLICT OF INTEREST

    None declared.

    FUNDING

    None

    REFERENCE

    1. Schaefer TJ, Szymanski KD. Burn Evaluation And Management. 2022 Aug 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 28613492.
    2. Sushruta. Su 23/18, Chi 1/7. In: Y T Acharya (eds.) Sushruta Samhita. Varanasi: Chaukhambha Publications; 2006. p396

    Image 1. Baseline Image - before treatment 

    baseline_image.png

    Image 2. Timeline of events second-degree-burn-_superficial.jpg

    Image 3. During treatment image 

    during_treatment.png

     

    Image 4. After treatment image 

    after_treatment.png

     

    Image 5. Follow up image 

    follow_up_image.png

  • Immersive Learning

    • Modern Diagnosis

      BIOMEDICAL DIAGNOSIS: Second-degree Burn

      ABOUT THE DISEASE:

      A burn is damage to your body's tissues caused by heat, chemicals, electricity, sunlight or radiation.

      There are three types of burns:

      • First-degree- The burn is limited to only the outer layer of skin

      • Second-degree- The burn affects the outer layer and the layer underneath

      • Third-degree- The burns damage or destroy the deepest layer of skin and tissues underneath. [1]

      Diagnostic criteria: A diagnosis is usually done based on depth of the burn. The extent/intensity of a burn is based on the "rule of nines."

      Treatment: Treatment decisions are based on the need to relieve pain, reduce swelling, prevent infection, and promote healing. The cause of burn- thermal, chemical, electrical or radiation is also an important factor in deciding the treatment plan.

      In this case report, the 63-year-old male patient, spilled hot water on his leg accidentally causing the burn. He immediately applied toothpaste at the site of the burn, which resulted in the peeling of the skin. After 2 days, he approached Dr Sateesh presenting with pain and a burning sensation at the site of the burn. On physical examination, completely peeled-off skin with redness at the burn site, and no blisters were noted. The physician diagnosed the case as a Superficial second-degree burn based on physical examination and presenting complaints.

      Prognosis: The pain associated with superficial burn with partial thickness is severe. Healing typically occurs within three weeks with minimal scarring. The outcomes of burn patients depend on the degree and extent of the burn. Most second and third-degree burns require prolonged admission, and recovery is slow. In this case, the redness disappeared, and healthy skin regrowth started with 1 week of Ayurvedic treatment. After 2 weeks of treatment, the wound completely healed without any scar. In further follow-ups, the near-normal colour of the skin was regained.

      Image 1. Image of the site of burn at baseline

      Reference

      1. Schaefer TJ, Szymanski KD. Burn Evaluation And Management. 2022 Aug 23. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2023 Jan–. PMID: 28613492.

      Image 1. Image of the site of burn at baseline

      baseline_image.png

    • Ayurveda Diagnosis

      AYURVEDA DIAGNOSIS: Shudha vrana

      ABOUT THE DISEASE:

      ‘व्रण’गात्रविचूर्णने, व्रणयतीति व्रणः॥६॥(su.ch 1/6)

      A wound is a loss of continuity of skin or mucus membrane due to injury. Classically Vrana is defined as ‘gatra vichurnana’ and causes the vivarnata of shareera. Acarya Sushruta has mentioned Shashti upakrama for the management of Vrana, which includes vranaropana formulations.

      Prognosis:

      त्वङ्मांसजः सुखे देशे तरुणस्यानुपद्रवः |

      धीमतोऽभिनवः काले सुखसाध्यः स्मृतो व्रणः ||३६||

      गुणैरन्यतमैर्हीनस्ततः कृच्छ्रो व्रणः स्मृतः |

      सर्वैर्विहीनो विज्ञेयस्त्वसाध्यो निरुपक्रमः [१] ||३७|| (CS.Ci. 25)

      A wound is easily curable if located in skin and muscles, in accessible places, at a young age, without complication, in a wise patient and is of recent origin. If it is devoid of some of the above mentioned factors, it is curable with difficulty. When it is devoid of all the above-mentioned factors, it is incurable and has to be refused treatment.

      Treatment:

      The management of Vrana as per Ayurveda involves; the healing of Vrana, which is described as Ropana. The various avasthas of Vrana, are Dushtavastha, Shuddhavastha, Ruhyamanavastha and Rudhavastha. The Ropana has to be planned taking into consideration the avastha of the vrana. Multiple factors affect the healing process, such as; age, sthana, sex, presence of other diseases (diabetes, skin disorders & tuberculosis), environmental conditions, ahara-vihara & presence of other poisonous bodies.

      In this case, the patient presented with pain and a burning sensation at the burn site. The treating physician diagnosed the burn wound as Shuddha Vrana based on physical examination and the presenting complaint.

      जिव्हातलाभो मृदू स्निग्ध: श्लक्षणो विगत वेदना||

      The rationale of treatment:

      The clinician adopted Vrana ropana line of management. Ghrita is best for Vrana ropana. Since Vrana is associated with daha, Mahatiktakam has been prescribed for external application. Triphala Dhara prevents infection and reduces inflammation. Triphala Guggulu and Nimbamrutasavam- promote healing and reduce pain.

       

    • Treatment

      Name of Medicine Dosage Form Dosage Mode of Administrtation From - To (Date) Medicine Reference
      Triphala Guggulu Tablet 1-1-1 Oral 2022-01-15 - 2022-01-21 Sharangadhara Samhita. Madhyama Kanda.7.52-53
      Nimbamrutasavam Asavam 30ml-0-30ml Oral 2022-01-15 - 2022-01-21 AH.Ci. Vatavyadhi.57-61
      Triphala dhara Dhara One hourly External application 2022-01-15 - 2022-01-29 Anubhuta prayoga
      Mahatiktaka ghritam Ghritam One hourly after dhara External application 2022-01-15 - 2022-01-29 Bhaishajyaratnavali.Kushtadhikara.118-124.

    • Outcome Measures

      Clinical outcome:

      63 year old male patient presented with a second-degree burn wound at the anteromedial aspect of right leg caused by accidental spilling of hot water. The condition was treated as Shudha Vrana. Clinical assessments made on basis of the skin colour appearance and granulation tissue growth. The redness disappeared, and skin regrowth started within one week of treatment. After two 2 weeks of treatment- the wound completely healed without any scar. In further follow up after 2 weeks, the near-normal colour of skin was regained. 

      Image 1. During treatment dated 21/1/2022 

      during_treatment.png

      Image 2. After treatment dated 1.2.2022

      after_treatment.png

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