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Thursday, March 4, 2010

Betadine ointment, Povidone- iodine, does betadine cause chemical burn or allergy?

Doc, I used betadine ointment on my 4 month old son who had a burn with hot water and I found the normal skin around the burn became red. Does betadine cause a skin burn?

+Kessler B

Thank you very much for the question. I am sorry that your baby had a burn. Let me give you a little detail about the ointment you used.
Betadine (Mundipharma, Switzerland) is a broad spectrum microbicide ( works against a lot of microorganisms, germs, virus, protozoa, spores, fungi and yeast) used regularly in wound care and wound management. Betadine is the trade name and the actual active substance in it is povidone – iodine. Iodine as an element was discovered in 1811 and the application of iodine solution caused pain, irritation and skin dicolouration. Since 1949 the development of iodophores (povidone, iodine and cadexomer iodine) helped form safer and less painful preparations.In the old days we used iodine, but now this has been replaced by povidone- iodine. Betadine can be used as an antiseptic for burn wounds, infected wounds, surgical wounds, leg ulcers, minor cuts and skin grazes. It is also used as a pressure sore cream in the management of bedsores. Burn Surgeons use it to kill the bacteria or germs and prepare the skin prior to making a surgical incision by painting the skin with betadine lotion. Betadine helps in wound healing by controlling and preventing infection when used as a dressing for burns wounds in burn management.

Betadine should not be used in patients with allergy to iodine as severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue)can occur. Since it contains iodine it should be avoided in patients with hyperthyroidism or increased activity of the thyroid gland or in patients with thyroid disease. Similarly we should be very cautious of its use in newborn babies and infants as the iodine can be absorbed through the unbroken skin. It should also be avoided in pregnant and lactating women as well as in elderly patients and patients with kidney dysfunction. One should avoid combining the use of povidone iodine with other ointments since it reduces the efficacy or can even damage the skin. While using this ointment the thyroid function test if carried out concomitantly, will show wrong results. Betadine can cause pain in some patients and can also reduce the immunity in others. Betadine is only for external application and should not be ingested or applied in the eye. Betadine or povidone -iodine, a wound care product is available in the following forms: betadine ointmint, betadine lotion, betadine solution, betadine gel, betadine powder, betadine aerosol, betadine paint, betadine mouthwash, betadine surgical scrub, betadine suppository and betadine skin cleanser.

Does it really cause a burn?

More than 13 cases of povidone-iodine–induced burn has been reported in the medical literature. This occurs when the povidone-iodine has not been allowed to dry or has been trapped under the body of a patient in a pooled dependent position. The burn is usually seen immediately after the procedure or on the next day, and typically heals with minimum scarring within 3–4 weeks with conservative treatment. The commonly postulated mechanism is a chemical burn due to irritation coupled with maceration, friction, and pressure. If betadine causes the chemical burn, I don’t really see what maceration, friction and pressure has to do with it. But that’s the way, whether from allergy or chemical burn, betadine can cause a skin burn which needs to be kept in mind.
As with the use of any ointment one can have an allergic reaction which is often taken as a chemical burn since betadine is a chemical and the skin reaction looks like a burn. Severe allergic reactions or hypersensitivity can easily be differentiated easily based on the symptoms mentioned previously. Infants have a delicate skin and one should try diluting the betadine before use, the first time and the slowly increase the concentration to make sure there is no allergy or chemical burn. Also its use should be limited to a very short period and physician supervision is recommended.

How do we treat it?
Well, stop using the ointment and change to Neosporin, fusidin or other ointments on the unburnt areas which show this chemical burn or allergy. Sometimes the use of steroids creams may help to treat the allergy element, but each case has to be judged and treated accordingly by the supervising physician. For the burnt areas use other ointments that are available for burn management. You can check these in the previous articles:
Management of 2nd degree superficial burns- (2nd degree burns)
Management of 2nd degree burns (deep), Skin grafting
I hope this answers your queries and I wish your son a speedy recovery.
With best regards,