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 In the old days we used iodine, but now this has been replaced by povidone- iodine.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+

What is Duoderm?(wound dressings)

Dear doctor, my husband has been bedridden for the past two years following an accident when he was hit by a drunk driver. He’s been having a bedsore for 3 months on his lower back. The doctor recently changed his wound dressing to Duoderm. Doc, what is Duoderm and will it help heal his wound? Thanks,

Clare P
Texas.

Thank you very much Mrs Clare for the question. I am sorry your husband had this injury and is bedridden. To understand wound dressings better it will be helpful to go through our previous article where we described different wounds and what dressings to choose in order to heal them:

How to choose wound dressings? (Wounds, wound healing, wound dressings) - http://asktheburnsurgeon.blogspot.com/2010/10/how-to-choose-wound-dressings-wounds.html

Duoderm is a hydrocolloid dressing agent which is made up of microgranular suspension of natural and synthetic polymers like pectin or gelatine that is placed in an adhesive matrix. As the wound exudate is absorbed, the dressing granulates in the Duoderm changing from a semi hydrated state to a gel state. The wound is therefore kept moist all the time and this helps wound healing. The exudate is also absorbed so that frequent dressing changes are not required.

Duoderm is produced by Convatec and provided as sterile sheets which should be cut and applied over the wound. There should be an overlap of 2 cms beyond the skin margins- so that adhesive Duoderm will not allow exudate to pass through and no additional dressings are required before applying Duoderm. One must clean the wound thoroughly and pat the skin around to make it dry so that the Duoderm patch will adhere well. Duoderm is good for dry necrotic wounds or for wounds that have little exudate. It can also be applied over granulating wounds or small ulcerated areas that break down by repeated dressings.                                                   

                                                   

Duoderm should be avoided in patients who have shown pervious allergy to it or its components. For dry or in very lightly exuding wounds, the dressing can be left in place for more than 3-5 days. If the exudate starts to leak, more frequent dressings will be needed.

There are other hydrocolloid dressings which work on a similar principle like:

Granuflex

Combiderm

Tegasorb

Comfeel

When using Duoderm dressing, one should take care to see that the wound does not develop infection which may go unnoticed. If this happens, then one must use dressings with antimicrobial agents along with specific antibiotics if needed.

The application of Duoderm helps to keep the wound moist and promotes wound healing but as with all wound dressings deciding which dressing to apply over a particular wound is the most important factor that will determine if a wound will heal rapidly.

So Ms Clare I hope that your doctor has chosen the right wound dressing and that your husband’s wound will heal rapidly.

With best regards,

Asktheburnsurgeon+