|Year : 2018 | Volume
| Issue : 2 | Page : 17-21
The cost of burn wound care in low-income nations could be reduced with the use of palm kernel oil: A preliminary study
Muhammad H Ibrahim1, Habiba Aminu2, MomohSani A Yakubu3, Aliyu Muhammad4, Rilwan O Maleeq1
1 Plastic Surgery Unit, Kebbi State University of Science and Technology, Kebbi, Nigeria
2 Biochemistry Department, Kebbi State University of Science and Technology, Kebbi, Nigeria
3 Anaesthesia Department: Federal Medical Center, Birnin Kebbi, Nigeria
4 Ministry of Animal Health, Husbandry and Fishery, Birnin Kebbi, Nigeria
|Date of Web Publication||28-Nov-2018|
Dr. Muhammad H Ibrahim
Surgery Department, FMC Birnin Kebbi, PMB 1126 Birnin Kebbi, Kebbi State
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Palm kernel oil, Shea butter and honey are used traditionally for the treatment of variety of ailments in West Africa, but there are no scientific report on burn wound healing activity of Shea butter and palm kernel oil, although honey has been in use for the treatment of burn wound. This study aim to compare the wound healing effect of these organic compounds (palm kernel oil, Shea butter and honey) in the treatment of deep dermal or full thickness burn wound to the conventional Silver sulfadiazine and povidone iodine creams in laboratory albino rats. MATERIALS AND METHODS: 25 rats weighing from 250–300 grams were randomly divided into five groups. About 225 mm2 deep dermal burn/or full thickness burn wound was created on the dorsum of the rats. The burn wound were dressed every alternate day with group (1) treated with honey; group (2) Shea butter; group (3) palm kernel oil; group (4) 1% silver sulfadiazine and group (5) 5% povidone iodine cream. Epithelialization observed and contraction was measured at the time of the dressing. FINDINGS: There was rapid reduction in the wound size by day 6 (P≤0.05) in the palm kernel and povidone iodine cream treated group and by day 8 the wound in both group were completely closed, the Shea butter treated group wound shows significant contraction by day 10 and the wound were closed only from day 14 on ward. CONCLUSION: Palm kernel oil is an affordable and readily available topical agent that holds potential for rapid burn wound healing.
Keywords: Burn wound, low-income nations, organic compounds, palm kernel oil
|How to cite this article:|
Ibrahim MH, Aminu H, Yakubu MA, Muhammad A, Maleeq RO. The cost of burn wound care in low-income nations could be reduced with the use of palm kernel oil: A preliminary study. Nigerian J Plast Surg 2018;14:17-21
|How to cite this URL:|
Ibrahim MH, Aminu H, Yakubu MA, Muhammad A, Maleeq RO. The cost of burn wound care in low-income nations could be reduced with the use of palm kernel oil: A preliminary study. Nigerian J Plast Surg [serial online] 2018 [cited 2019 Jan 22];14:17-21. Available from: http://www.njps.org/text.asp?2018/14/2/17/246154
| Introduction|| |
Burn injuries are among the most devastating of all injuries and a major global public health crisis., Burns are the fourth most common type of trauma worldwide, following traffic accidents, falls, and interpersonal violence., Over 6.6 million people worldwide suffer from burns, and almost 265,000 of them die annually., About 1% of all deaths are related to burn injuries.
Approximately 90% of burn-related deaths occur in low and middle-income countries (LMIC), regions that generally lack the necessary infrastructure to reduce the incidence and severity of burns. Nigeria and many African countries are part of these nations (LMIC). Burn injuries account for 4.8% of trauma deaths in Nigeria and 6.7% of surgery-related deaths.
There are many topical agents which are used for burn wound treatment. The most commonly used in the treatment for burn wound is silver sulfadiazine (SSD) 1% cream with antibacterial activity. Other topical agents available for our routine use in burn wound care is povidone iodine creams and solutions. These and other advanced wound care products like nanocrystalline silvers and silicons (Mepitel, Molnlycke Health Care AB, Gothenburg, Sweden) are very expensive and beyond the reach of most of our burn patients in LMIC.
Several natural products have been used for the management of burn wounds that could be considered as an alternative source of treatment of burn wounds. These products have been offered as more effective and cheaper treatment agents. Palm kernel oil, shea butter, and honey are used traditionally for the treatment of variety of ailments in West Africa, but there are no scientific reports on burn wound healing activity of shea butter and palm kernel oil, although honey has been in use for the treatment of burn wound. Shea butter has also been used for soothing and accelerating healing after circumcision and for preventing stretch marks in African pregnant women and as an insect repellent, providing protection against Simulium infection. Oil from the African oil palm Elaeis guineensis has long been recognized in West African countries. European merchants trading with West Africa occasionally purchased palm oil for use in Europe, but palm kernel oil remained rare outside West Africa., Thus, there is a paucity of investigations on this oil.
Palm kernel oil is an edible plant oil derived from the kernel of the oil palm E. guineensis. It should not be confused with the other two edible oils derived from palm fruits: coconut oil, extracted from the kernel of the coconut, and palm oil, extracted from the pulp of the oil palm fruit. Palm kernel oil, coconut oil, and palm oil are three of the few highly saturated vegetable fats; these oils give the name to the 16-carbon saturated fatty acid palmitic acid that they contain. Palm kernel oil, which is semisolid at room temperature, is more saturated than palm oil and comparable to coconut oil.
Palm kernel oil is extracted from the nut, or kernel, of a species of African palm tree. It is commonly referred to as tropical oil. Palm kernel oil is primarily composed of fatty triglycerides, with approximately 80% saturated fats and 20% unsaturated fats.
With this background, we designed this study to compare the burn wound healing effect of these organic compounds (palm kernel oil, shea butter, and honey) in the treatment of deep dermal or full thickness burn wound to the conventional SSD and povidone iodine creams in laboratory white albino rats.
| Materials and methods|| |
Shear butter, palm kernel oil, and honey were all purchased from Bush markets of Zuru and Adavi of Northwest and Northcentral, respectively, in Nigeria (costing about $2/L/each). The 1% silver sulphadiazine (Dermazine—Salutas Pharma Gmbh, Barleben, Germany) and 5% povidone iodine (WOSAN—JAWA, India) creams, normal saline, and Savlon antiseptic solution were purchased from our local pharmaceutical shops. Both Dermazine and WOSAN creams cost $1/15-g tube each.
A total of 25 healthy white albino rats, of either sex but same age, weighing between 200 and 300 g were obtained from the Department of Pharmaceutical Sciences, Ahmadu Bello University, Zaria. The animals were acclimatized in standard environmental conditions of temperature, humidity, and a 12-h light and 12-h dark cycle. Rats were fed with standard grower mash product of vital feed and water, and the container for the food was washed daily. The care of the rats and the experiment was done in accordance with the internationally accepted principles of laboratory animal use and care and the Animal Experimental Protocol of the Kebbi State University of Science and Technology under the supervision of a veterinarian.
The rats were randomly selected into five groups (N = 5): shea butter, honey, palm kernel oil, silver sulphadiazine, and povidone iodine.
Each rat had its dorsum cleansed with chlorhexidine (Savlon, Glaxosmithkline, Brentford UK) and the skin shaved. They were all anesthetized via intramuscular route on the thigh with 100 mg/kg of ketamine injection by an anesthesiologist. A metal spatula with 225-mm2 surface was heated up to 100°C with burning flame of candle wax. The hot metal was applied on the shaved dorsum for 5 to 10 s with equal pressure to create about 225-mm2 surface area burns of second degree deep to third degree.
Each rat had its wound cleansed with normal saline daily and 1 to 2 ml of above topical agents applied on the burn wound accordingly. Wound contraction was measured with clinical meter rule on alternate days, while were observed both macroscopically and with picture as evidence by falling off of eschar or appearance of hair growth.
The data were collected and analyzed using Microsoft Excel 2007 (Microsoft Office 2007, Service pack 3).
| Results|| |
There was rapid reduction in the wound size by day 6 (P ≤ 0.05) in the palm kernel and povidone-iodine cream treated group, and by day 8, the wound in both group healed completely [[Figure 1]a and 1b]. The shea-butter-treated group wounds showed significant contraction only from day 10 and the wound were closed only from day 14 onward, showing tendency for delayed wound healing. There was initial increase in burn wound surface area with honey-treated group before the wound contraction and epithelialization steadily reduced [[Figure 2] and [Table 1]].
|Figure 1: (a) Wound of palm-kernel-treated rat at day 2 before commencement of treatment and (b) palm-kernel-treated rat at day 8.|
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|Figure 2: Comparison of wound contractions between the three organic compounds and two topical burn wound care agents.|
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|Table 1: Average wound size of each group of rat treated with shear butter, silver sulfadiazine, honey, palm kernel, and povidone iodine in alternate days of experiment|
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| Discussions|| |
This is a pioneering pilot study to scientifically document the possibility of using our traditional topical agents in burn wound care which are available and affordable. Despite recent advances in wound care products, traditional therapies based on natural origin compounds, such as plant extracts, honey, and larvae, are interesting alternatives. These therapies offer new possibilities for the treatment of skin diseases, enhancing access to health care and helping to overcome limitations associated to modern products and therapies, such as the high costs, the long manufacturing times, and the increase in bacterial resistance.
The initial wound size increment with honey group in this study may be due to its autolytic debriding and escharolytic properties. It may also due to wound infection which we did not study in this work. More so, wound healing effect of honey depends on the type of honey, and our honey was not medical grade type but usually effective in wound care.
The tendency for delayed wound healing in acute burn wound noticed in this study with shea butter oil may be an indicator that it is not good for acute burn wound as it is for traditional scar treatment. Further and detailed studies of this product are needed to validate these preliminary observations.
Most fascinating result of this work is the significant rapid wound size reduction and epithelization of wounds of the rats treated with palm kernel oil. It was closely comparable to the effect of broad-spectrum topical antiseptic (5% povidone iodine) Cream performed even better than the 1% silver sulphadiazine in this work. This finding is similar to the work of Sreenivasan et al. on significant wound closure effect of E. guineensis (oil palm) leaf-extract-treated wounds that started closing from day 4 and completed at day 16 of the experiment.
Although the detailed phytochemical analysis of this palm kernel oil was not readily available for review, however, the presence of terpenoid in its leaf extract may be responsible for the wound healing actions. Terpenoids are known to promote the wound healing process, mainly due to their astringent and antimicrobial properties, which seem to be responsible for wound contraction and an increased rate of epithelialization.Natural wound healing is easy and effective with essential oils. Whether it is a puncture wound or a scrape, therapeutic grade essential oils can quicken the healing process because they contain multiple medicinal properties. For instance, here are a few of the properties we want for healing wounds: antibacterial, antifungal, analgesic, antiseptic, anti-inflammatory, antibiotic, homeostatic, and vulnerary.
| Limitations of study|| |
However, this finding are not conclusive due to the following limitations on the study: It was a simple randomized preliminary study with no histopathological evaluation, no antimicrobial property assessment, negative control was not included, and burn wound surface created may be relatively small.
| Recommendations|| |
We are recommending further randomized controlled study of this oil, comparing it with both positive and negative controls with larger wound size. Subsequent phytochemical analysis before clinical trials that may eventually lead to its use on our patient is highly recommended.
| Conclusion|| |
Palm kernel oil is an affordable and readily available topical agent that holds potential for rapid burn wound healing.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Forjuoh SN. Burns in low- and middle-income countries: A review of available literature on descriptive epidemiology, risk factors, treatment, and prevention. Burns 2006;32:529.
Peck MD, Kruger GE, Van der Merwe AE, Godakumbura W, Ahuja RB. Burns and fires from non-electric domestic appliances in low and middle income countries Part I. The scope of the problem. Burns 2008;34:303–11.
Penn JW, Grobbelaar AO, Rolfe KJ. The role of the TGF-β family in wound healing, burns and scarring: A review. Int J Burns 2012;2:18–28.
Mogosanu GD, Popescu FC, Busuioc CJ, Lascar I, Mogoanta L. Comparative study of micro vascular density in experimental third-degree skin burns treated with topical preparations containing herbal extracts. Rom J Morphol Embryol 2013;54:107–13.
Sadeghi-Bazargani H, Mohammadi R. Epidemiology of burns in Iran during the last decade (2000–2010): Review of literature and methodological considerations. Burns 2012;38:319.
Murray CJL, Lopez AD. The global burden of disease. A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Swizerland: World Health Organization; 2006.
Solagberu BA, Adekanye AO, Ofoegbu CP, Udoffa US, Abdur-Rahman LO, Taiwo JO. Epidemiology of trauma deaths. West Afr J Med 2003;22:177–83.
Adesunkanmi AR, Akinkuolie AA, Badru OS. A five-year analysis of death in the accident and emergency room of a semi-urban hospital. West Afr J Med 2002;21:99–104.
Khorasani GA, Hosseinimehr SJ, Azadbakht M, Zamani A, Mahadavi M. Aloe versus silver sulfadiazine creams for second-degree burns: A randomized controlled study. Surg Today 2009;39:587–91.
Miller AC, Rashid RM, Falzon L, Elamin EM, Zehtabchi S. Silver sulfadiazine for the treatment of partial-thickness burns and venous stasis ulcers. J Am Acad Dermatol 2012;66:159–65.
Nasiri E, Hosseinimehr SJ, Azadbakht M, Akbari J, Enayati-Fard R, Azizi S. Effect of Malva sylvestris
cream on burn injury and wounds in rats. Avicenna J Phytomed 2015;5:341–54.
Goreja WG. Shea butter: The nourishing properties of Africa’s best-kept natural beauty. New York, NY: Amazing Herbs Press Oxford University Press 2004. pp 38–9.
Carr JD. Combretaceae
in Southern Africa. Johannesburg: Tree Society of Southern Africa; 1988.
Iwu MM. Handbook of African medicinal plants. Florida, USA: CRC Press 1993.
Kudi AC, Umoh JU, Eduvie LO, Gefu J. Screening of some Nigerian plants for antibacterial activity. J Ethnopharmacol 1999;67:225–8.
Oliver-Bever B. Medicinal plants of tropical West Africa. London: Cambridge University Press 1986. pp 164.
Pereira RF, Bartolo PJ. Traditional therapies for skin wound healing. Adv Skin Wound Care 2016;5:208–29.
Khoo YT, Halim AS, Singh KK, Mohamad NA. Wound contraction effects and antibacterial properties of tualang honey on full-thickness burn wounds in rats in comparison to hydrofibre. BMC Complement Altern Med 2010;10:48.
Sreenivasan S, Rajoo N, Rathinam X, Lachimanan YL, Rajoo A. Wound healing potential of Elaeis guineensis
Jacq leaves in an infected albino rat model. Molecule 2010;15:3186–99.
Scortichini M, Pia Rossi M. Preliminary in vitro evaluation of the antimicrobial activity of triterpenes and terpenoids towards Erwinia amylovora
(Burrill). J Bacteriol 1991;71:109–12.
Chithra P, Sajithlal GB, Chandraksan G. Influence of Aloe vera on the healing of dermal wounds in diabetic rats. J Ethnopharmacol 1998; 59:195–201.
[Figure 1], [Figure 2]