Topical Reactions

Topically applied garlic can cause "garlic burns" as well as allergic garlic dermatitis. A 17-month-old infant suffered partial thickness burns when a plaster made of garlic in petroleum jelly was applied to the skin for 8 hours (98). Another infant, age 6 months, suffered garlic burns when his father, disappointed that no antibiotics had been prescribed for a treatment of sus pected aseptic meningitis, applied crushed garlic cloves by adhesive band to the wrists for 6 hours (99). After 1 week, a round ulceration 1 cm in diameter surrounded by a slightly raised, erythematous border was noted on the left wrist. A similar, more superficial lesion was also seen on the right wrist. When questioned, the parents explained that these ulcerations were the residual blisters that had formed after garlic application. The author of this case report described this reaction as a second-degree chemical burn. An allergic mechanism was ruled out because the infant had not previously been exposed to garlic or onions. A patch test was not done for ethical reasons. Although Garty hypothesized that the infants' delicate skin predisposed them to garlic burns, such reactions have also been reported in older children and adults. For example, a 6-year-old child developed a necrotic ulcer on her foot after her grandmother applied crushed garlic under a bandage as a remedy for a minor sore (100).

A 38-year-old woman developed a garlic burn after applying a poultice made from fresh, uncooked garlic to her breast for treatment of a self-diagnosed Candida infection secondary to breastfeeding her 6-month-old son (101). Despite a burning sensation upon application, she left the poultice in place for 2 days. The infant continued to feed with no apparent adverse effects. She presented to the emergency room 2 days after removal of the poultice. Physical exam revealed that the area where the poultice had been applied appeared as a burn with skin loss, ulceration, crusting, hyperpigmentation, granulation tissue, serous discharge, minor bleeding, and erythema on the periphery. The area was tender. The patient was treated with 1% silver sulfadiazine cream.

Another adult suffered garlic burns after applying a compress of crushed garlic wrapped in cotton to her chest and abdomen for 18 hours (102). The erythematous, blistering rash was in a dermatomal distribution on the right side of the patient's chest and upper abdomen, approximating the dermatomal distribution of thoracic segments 8 and 9. She reported that the pain had been present for 1 week and had a stabbing quality. She was initially diagnosed with Herpes zoster and was prescribed acyclovir before admitting to use of topical garlic after further questioning. Biopsy revealed full thickness necrosis, many pyknotic nuclei, and focal separation of the necrotic epidermis from the dermis. The burns healed with scarring. The patient refused patch testing, and specific IgE RAST testing to garlic was negative. The nonspecific appearance of garlic burns has been exploited. Three soldiers applied fresh ground garlic to their lower legs and antecubital fossa to produce an erythematous, vesicular rash in an effort to avoid military duty (103).

Eight patients who developed contact dermatitis after rubbing cut fresh garlic cloves on fungal skin infections responded to a topical fluorinated ste roid but had negative garlic patch tests, suggesting irritation rather than allergy (104). Patch testing with 1% diallyl disulfide in petrolatum has also been recommended when allergy is suspected (105).

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