Garlic: A way out of work

Military Medicine, Jun 2003 by Lachter, Jesse, Babich, Jay P, Brookman, Jason C, Factor, Avi Y

Two 18-year-old men were seen for second-degree burns to the dorsum of their knees, ankles, and feet. Upon investigation, it was revealed that the burns were self-inflicted and resulted from the application of crushed garlic with the intent of exemption from work. Reviews of the literature reveal that garlic-induced burns have been previously reported; however, only once before as a factitious dermatitis. The sharp demarcation line between normal and abnormal skin should suggest that a burn is not from hot liquids. Health care providers had best be advised of the side effects of natural remedies and be aware of how garlic may be abused to the advantage of an individual.

Introduction

Garlic (Allium sativum) has been used since ancient times by many different cultures as a remedy for a wide variety of ailments. In the last century, its prophylactic use against hypercholesterolemia, hyperlipidemia, and atherosclerotic plaque formation has been recognized.1 Within the last decade, a few cases of chemical burns associated with the topical application of garlic for the treatment of miscellaneous illnesses were reported. One interesting case of purposeful garlic-induced dermatitis involved three individuals seeking exemption from work during mandatory military service. We now report on the cases of two 18-year-old men who attempted to be excused from their work for which closed boots were required by applying garlic directly onto their legs, which resulted in burns. When examined, they explained that the burns resulted from accidental spillage of a hot beverage.

Case Reports

Two 18-year-old men have been seen in one outpatient clinic for second-degree burns to the dorsum of their knees, ankles, and feet. When questioned, the individuals claimed to have accidentally spilled hot coffee on themselves. Upon examination, however, the burns appeared to be of a different origin (Fig. 1). Whereas a coffee burn would cause uneven borders because spillage runs down the foot by gravity, the borders of these burns had an even lower boundary of demarcation. Further questioning revealed that the burns were self-inflicted and resulted from the topical application of crushed garlic with the intent of self-mutilation that would lead to exemption from work.

Discussion

The use of garlic as a medicine dates back to ancient Egypt where the builders of the pyramids took garlic as a prophylaxis against disease. Jewish literature is quite full of praise for this common herb: its ability to satisfy hunger, stimulate salivation, increase fertility, destroy intestinal parasites, and increase visual acuity.2 Additionally, chicken soup was apparently established as a cold remedy approximately 800 centuries ago when Maimonides, court physician to the caliph of Egypt, first recommended chicken soup with significant amounts of onion and garlic-natural antibiotics-to be highly effective against the flu virus.3 During the Hippocratic era, it was used to treat leprosy, intestinal disorders, and chest pains.4 In the twentieth century, garlic has been used as an antipyretic, antimicrobial, anti-fungal, and antiparasitic agent.4 Most recently, because of its prophylactic properties against hypercholesterolemia, hyperlipidemia, and atherosclerotic plaque formation, its use has been directed to the prevention of coronary artery disease.1

Adverse reactions to garlic have been reported, including nausea, vomiting, diarrhea, bronchospasm, asthma, facial flushing, insomnia, and contact dermatitis.5 In 1952, garlic-induced allergic contact dermatitis was noted in homemakers and cooks.6 Chemical irritation to garlic is attributed to its monosulfides, disulfides, and trisulfides, especially diallyldisulfide, the strongest chemical sensitizer.7 Allergic contact dermatitis produced by the garlic is an epidermal, rather than a dermal, reaction. However, garlic can cause such severe burns that skin grafting may become necessary.

In addition to the cases presented here, there is only one other description of factitious dermatitis induced by the application of garlic. Kaplan et al.8 reported on three soldiers with erythematous blistering lesions on the knees, ankles, and right antecubital area following the rubbing of freshly ground garlic onto these areas for the intention of improving their military assignments. Debridement of the wounds and application of Flamazine or Silvadene to the affected areas was the treatment for most of the cases listed above. Skin grafting would be necessary for very severe burns. Soldiers, and others in various work situations, may be tempted to self-induce lesions that will make the wearing of safety boots for certain kinds of work infeasible.

Conclusions

The present case is important in that health care professionals need to be cognizant of the adverse, as well as of the beneficial, effects of garlic. This case is a reminder that a sharply demarcated lesion is not likely to be a result of accidental spillage of any hot beverage. Physicians should be aware of naturopathic remedies and their undesirable side effects and should include questions about these remedies in their history taking.