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Monday, January 24, 2011

Iodine burns!!!

Hello doctor,


Two days ago I was bit by a tick in my yard. I pulled the nasty little bug off and was rid of it quickly. I had a bit of a welt so I treated it quickly with a warm vinegar compress and have been eating raw garlic for antibiotics. This morning the welt is a bit irritating, so I decided to put some iodine on a small piece of gauze and tape it to the area while I got ready for work- I felt it sting and thought nothing of it except that is was obviously a good antiseptic-but then my skin felt like it was on fire, so when the bandage came off all the iodine in the gauze was of course in my skin and I do not ever remember iodine burning like this, but the skin is on the stomach area and is more sensitive. I have put some antibiotic and zinc ointment on it. Will this cause me more of a problem? I am sure it killed any of the saliva from the tic.

Thank you for your time.
Catherine

Dear Catherine,

Thank you very much for your letter and we are sorry for the delay due to a huge backload of queries.
Iodine, discovered by Bernard Courteous in 1811, is quite an irritant to the skin and in general one should avoid applying iodine directly over the skin. The application of iodine solution causes pain, irritation and skin discolouration. 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 In the old days we used iodine, but now this has been replaced by povidone- iodine. Some patients can develop an allergic reaction to iodine (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue). Others can end up with a chemical burn if the iodine is used in higher concentrations.
In your case the tick bite itself could end up in skin inflammation and infection that could give a similar picture. In case it appears like a chemical burn, then one should treat it like a burn. You need to clean it with a dilute antiseptic solution or sterile saline thrice a day and apply an antibiotic ointment like Neosporin or fusidic acid ointment. You can also take some pain killers like ibuprofen, paracetamol, diclofenac sodium etc, though in a day or two the pain should reduce considerably. You may also use closed daily dressing if this is more convenient. The affected site should be watched for any sign of infection as this is a tick bite and antibiotics should be started if this happens. Once the area heals use a bland skin moisturizer to nourish the new skin and use a sunscreen to avoid pigmentation (darkening) of the new skin from sun exposure. If allergy is the cause then a steroid cream can be added. However tick bites can cause acute infection, as well as other disease like tularaemia and I feel that your physician needs to decide whether you need to prophylactically treat this with antibiotics. A visit to your doctor will be helpful as this advice is given without actually seeing you in person.

You should also read these related articles;
Management of 2nd degree superficial burns- (2nd degree burns)
http://asktheburnsurgeon.blogspot.com/2010/01/management-of-2nd-degree-superficial.html
tick bite management
http://www.emedicinehealth.com/ticks/article_em.htm

Wishing you a speedy recovery,
Asktheburnsurgeon+

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