Dermatoses due to Quackery: A Case Snippet and Concise Review of Literature.

A wide prevalence of socio-religious, cultural, and tribal practices in India often leads to a multitude of skin conditions, which can misled the dermatologists in arriving at a diagnosis. With increasing globalization and migration, the practice of indigenous customs and traditions are crossing boundaries, making it imperative for the dermatologists to be acquainted with the cutaneous side effects of these practices. Here, we report a unique case of thermal burn in a circumferential pattern over the umbilical region, a result of the placement of burning lamp over umbilicus to alleviate abdominal discomfort.

What was known?

Quackery is rampant among many parts of India.

Many types of skin diseases and eruption can occur due to practices employed by quacks.

Introduction

India is a land of diversity. Various religious beliefs, socio-cultural and religious practices, and quackery to treat varied medical problems often result in a host of secondary dermatoses. With increasing civilization and migration of population, the indigenous cultural practices are no longer confined to particular regional territories. Herein, we describe a case of quackery aimed to improve abdominal discomfort, however, leading to peculiar skin eruption thereafter.

Case Report

A 44-year-old immunocompetent married male was referred for an opinion on multiple strange appearing blisters on the abdominal wall since 3 days. On examination, multiple flaccid to tense bullae of size ranging from 1 to 3 cm over erythematous base arranged in a circumferential pattern with a well-defined erythematous margin were present on periumbilical area [Figure 1]. Per abdominal examination showed distension along with guarding and rigidity.

Figure 1

Multiple hemorrhagic blisters on abdominal skin in a periumbilical area with circumferential distribution

On further enquiry, the patient gave the history of abdominal pain and loss of appetite since last 7 days for which he was investigated on the surgical side and was diagnosed to have a small bowel obstruction. An operative procedure of resection and anastomosis was planned by the surgical team. However, the patient refused to get operated and returned home and visited a traditional healer accompanied by his wife. The healer gave the patient some unknown pills to consume, which made him to lose his consciousness. The traditional healer then placed five burning lamps made of wheat dough over his abdomen in the umbilical region and then placed a utensil upside down over his abdomen covering those lamps. The utensil was left in place for almost an hour. When the patient regained his consciousness, there was a temporary cessation of abdominal cramps, but the patient noticed multiple painful blisters over his abdomen in the later part of the day. We made a diagnosis of thermal burns resulting from burning lamps and managed the blisters symptomatically via draining and sterile dressings. We counseled the patient about graveness of his abdominal complaint and made him to get operated for obstructive pathology.

Discussion

“Quackery” is the promotion[1] of fraudulent or ignorant medical practices. A “quack” is a “fraudulent or ignorant pretender to medical skill” or a person who pretends, professionally or publicly, to have skill, knowledge or qualifications, he or she does not possess. In our case, the traditional healer placed the burning lamps around the umbilicus with a belief that disease (evil forces) may exit the body via natural body orifice (umbilicus) [Figures 2 and 3].

Figure 2

Lamps made of wheat flour dough arranged circumferentially over periumbilical area (the procedure was demonstrated on a ward attendant after due permission)

Figure 3

Burning lamps and utensil used in the procedure (not placed on actual patient due to ethical reasons)

“Branding” as a preventive or therapeutic measure for many diseases is widely practiced in many rural parts of India. Practitioners of branding believe that the offending agent can get out of the brand site relieving the body of disease.[2] The practice starts early in the neonatal period to treat physiological jaundice.[34] The practice may continue even in later part of life, as the local traditional healer administers the brand mark on different body parts based on the anatomical localization of disease pathology. Tip of a hot metal rod, heated nails, wires, incense sticks, and hot bangles are the commonly used objects to brand the child. The forehead, face, chest wall, and abdomen are the usual sites of branding. The pediatric patient usually belongs to a poor illiterate rural family where branding is a continuing tradition prevalent through many generations.[5]

“Neem (Azadirachta indica)” is one of the most ancient known traditional Ayurvedic medicinal plants and is considered to have numerous medicinal properties. Various parts of neem tree are used to treat various dermatological conditions (leprosy control, syphilitic sores and indolent ulcer, itching, skin ulcers, and eczematous dermatoses).[6] However, a large dose of neem can cause adverse effects including rashes, itching, and swelling and, in more severe cases labored breathing. Neem is considered to be unsafe in pregnancy when taken orally, as it can cause miscarriage.

“Semecarpus anacardium (biba)”, also known as “marking nut”, commonly used by washerman, is well-known for its value in Ayurvedic and Siddha system of Medicine. It is believed to be helpful in treating illnesses related to the heart, blood pressure, respiration, cancer, and neurological disorders.[7] However, it has been widely used by quacks for the treatment of rheumatic arthritis, nervous disorders to decrease pain, which often leads to irritation, painful blisters, and irritant contact dermatitis.

In developing countries, “neonatal tetanus and cord infections” continue to be an important cause of neonatal morbidity and mortality. Infants with neonatal tetanus often have a concomitant cord infection,[8] which points to a common cause (unclean delivery and cord care practices).[9] A wide variety of traditional practices and beliefs are associated with cord care. Instead of cord clamp, unqualified midwives use blades of grass, bark fibers, reeds, or fine roots are used to tie the cord, which are often laden with Clostridium tetani spores and increase the risk of neonatal tetanus.[9] Cord cutting/crushing is usually done with a variety of unsterile sharp instruments (scissors, knives, broken glass, stones, sickles, or used razor blades). In most cultures, some kind of substance is applied to the umbilical stump to prevent bleeding from the stump, to promote separation of the stump, and to keep spirits away. Cow, chicken or rat dung; ash, oil, butter, spice pastes, herbs, mud, and ghee[10] are the substances applied, associated with high risk of tetanus as they can be contaminated with bacteria and spores.

Conclusion

Dermatologists should be aware of different quackery practices rampant in various geographical areas. This can help them avoid unnecessary investigations in case of dermatoses due to quackery and arrive at prompt diagnosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

What is new?

Practice of quackery can result in unusual dermatological eruptions

A thorough history and a replay of events can provide useful clue in diagnosis.