H23 Traditional healing by skin cauterization (kaiy)

Abstract

Abstract The practice of kaiy is an ancient medical traditional therapy that is still used in Africa and the Middle East. Kaiy is the Arabic word for cautery; a red-hot iron or coal is placed to the skin. This causes sharp circular, oval or linear burns that are placed in a symmetrical configuration, usually resulting in permanent scars. This practice is undertaken by traditional healers. A Somali woman was referred by her general practitioner to dermatology for an itchy scar on her mid-upper abdomen. She reported that 40 years ago, she had traditional skin cautery therapy to the area for bone pain, which was later diagnosed as rheumatoid arthritis. On examination, she had a 4 × 0.7 cm keloid scar that was treated with a course of KenalogTM injections. This sparked an interest in understanding the practice of kaiy, and a literature review was performed. Cauterization results in the burning of tissue in order to close wounds or stop bleeding. The patient’s symptoms help to decide the location of cauterization. For example, if the presenting complaint is jaundice, the cautery is placed on the left hand. Other medical presentations that kaiy is used for include back pain, headache, depression, chest pain and exorcism. Is this practice useful or are patients being burned for no reason? Historically, it was felt that it was valuable in preventing infection; however, there is no scientific basis for this. The practice was believed to result in the destruction of pathogenic substances within the body due to the extreme heat. Patients who have undergone this therapy report that it gives them short-term relief of their symptoms; this is likely to be due to the release of endogenous opioids, allowing the body to stop the sensation of unremitting pain. Complications are commonly witnessed and consist of deep skin burns, deferred wound healing and secondary wound infections. More serious complications include septic shock, ulceration and viral transmission such as hepatitis B (Farid MK, El-Mansoury A. Kaiy (traditional cautery) in Benghazi, Libya: complications versus effectiveness. Panafr Med J 2015; 22:98; Budair F. Dermatoses due to Arabic cultural and traditional practices. Indian J Dermatol Venereol Leprosy 2019; 85:448–54). Kaiy should be included in the differential diagnosis of a patient presenting with multiple symmetrical scars. Some patients may not be forthcoming in admitting to the treatment if not specifically asked. This presentation aims to increase awareness in dermatologists of this practice.