An unusual cause of a chemical burn in an elderly patient

Abstract

The use of complementary and alternative medicine (CAM) has increased in popularity in western countries. We report the case of an elderly man who suffered a minor complication from the use of a topical CAM. A 73-year-old man with a background of osteoarthritis of the hips attended a geriatric day hospital for multidisciplinary input. On one visit, he brought the attention of nursing staff to an ulcerated area of skin overlying the greater trochanter of his right hip. When questioned further, the patient admitted applying a topical alternative remedy to the area for relief of arthralgia. This was in the form of a salve with an occlusive dressing, which had been purchased in an herbal remedy shop as an over-the-counter treatment. No written or verbal directions were given for its use. He had applied the remedy three weeks previously for three days, but removed it due to contact pain. The area had been ‘‘red and raw’’ on removal of the treatment. On review in the day hospital (3 weeks postremoval) a healing superficial chemical burn with eschar formation (4 cm by 3 cm, see Fig. 1) was noted. Similar topical agents previously used by this patient involved a plastic film to limit skin contact with the therapy; however on this occasion no plastic filmwas supplied. Nowritten instructionswere given. Review of the packaging disclosed that the ingredients included moxa, boswellic preparata, pubescent angelica root, and peppermint oil. Enquiry at point of purchase verified that