Introduction: Wound healing in burn patients presents a substantial clinical challenge. Various topical agents are available for the treatment of burn wounds. Facial burns present an increased challenge due to the complex management required, which impacts both physical recovery and psychological well-being.

Aim: This study aimed to assess the efficacy of some natural products in treating facial burns.

Materials and methods: The study included 50 patients grouped by age, sex, burn etiology, severity, and duration of treatment over a three-year period. Using an open approach technique, these patients received twice-daily applications of natural products such as oils, creams, and ointments. Gentle massage was used during application to ensure complete penetration of the products into the affected areas.

Results: Effective penetration of the oils and ointments into the eschar tissue was observed, facilitating rapid eschar separation and improved aesthetic results. Patients reported complete recovery within 10 days with favorable esthetic results. This protocol demonstrated successful management of superficial facial wounds.

Conclusions: Natural products proved effective in treating challenging wounds, including burns, edema, and post-surgical conditions, yielding positive outcomes.

conservative treatment, face burn, face scars, natural product, plants

Traumatic burn injuries are a major public health problem on a global scale, resulting in millions of people seeking medical attention each year. Natural disasters, industrial accidents and domestic incidents are often the cause of these injuries. In addition, in certain cases, burns can be an indication of child abuse, highlighting a serious underlying social issue that requires immediate attention.^{[1, 2]}

The management of burn injuries has evolved significantly, incorporating a multidisciplinary approach that spans from pre-hospital care to advanced surgical interventions. The initial management of burn injuries in a pre-hospital setting is crucial for improving patient outcomes. It involves steps to stabilize the patient, minimize tissue damage, and prevent complications such as infection and fluid loss. Effective pre-hospital care is of paramount importance, especially for severe cases that affect the airways and breathing, as approximately 60% of burn injuries involve the face and neck, which are critical to both function and appearance.^[3]

In modern burn surgery, there is an increasing interest in the use of natural products for the treatment of burn wounds. The rationale behind this approach is that natural products can help preserve tissue architecture and protect the dermal components, thereby reducing the risk of functional impairment and cosmetic disfigurement associated with pathological scarring. These natural products offer an alternative to synthetic agents, which may have undesirable side effects or be less effective in preserving tissue integrity.

The face, often regarded as the epicenter of individual identity and personality, is particularly vulnerable to trauma and burn injuries. Facial disfigurement can have profound psychological effects, leading to conditions such as post-traumatic stress disorder (PTSD) and depression. The psychological impact of facial burns necessitates a treatment approach that not only addresses the physical injury but also supports the mental and emotional well-being of the patient.

First- and second-degree facial burns are particularly suitable for treatment with the open approach method, which involves the application of topical agents to the wound surface to promote healing without the need for extensive surgical intervention. This method is advantageous as it allows for continuous assessment of the wound and reduces the risk of complications associated with surgical procedures.

A variety of natural products have been identified as effective in the treatment of burn wounds. These products often contain ingredients that provide multiple therapeutic benefits, including anti-inflammatory, antimicrobial, and wound-healing properties. Common natural ingredients include hyaluronic acid, which has been shown to promote moisture retention and tissue regeneration; aloe vera, which possesses soothing and healing characteristics; and oils such as olive oil and sesame oil, which have emollient and antioxidant effects. Other beneficial components include Ceratonia siliqua (carob), which has anti-inflammatory properties; lavender, which offers antiseptic and pain-relieving effects; and cucumber and potato extracts, which are known for their cooling and hydrating benefits. Additionally, shea butter, rich in fatty acids and vitamins A and E, helps to nourish and repair the skin, while skin lipids and various leaf extracts contribute to barrier repair and skin regeneration.^[4]

This study aimed to assess the efficacy of some natural products in treating facial burns.

This retrospective study examines the outcomes of treatment with natural products including combination of ingredients such as butyrum, skin lipids, Pyrus malus fruit extract, Stellarioides longibracteata leaf extract, tocopherol, Sesamum indicum seed oil, beewax, Phellodendron chinense bark extract, Scutellaria baicalensis root extract and Coptis chinensis rhizome extract in 50 patients with facial burn injuries and a control group of 50 patients treated with conventional medical burn treatments. The patients were stratified into subgroups based on variables such as age, sex, burn etiology, degree of burns, and duration of treatment. Among the participants, there were 27 women and 23 men (Fig. 1). The majority of the patients were adults (n=39), while the remaining were children (n=11) (Fig. 2). The predominant cause of burn injuries was exposure to flame, followed by burns from hot liquids and steam.

The burn severity ranged from superficial burns (first and second-degree, I-IIA) in 44 patients to deeper burns (second-degree, IIB) in five patients (Fig. 3). One patient presented with a third-degree burn, which required surgical intervention. The treatment protocol involved the application of natural products using an open approach, administered twice daily in doses of 0.5 ml spread on 1% burn surface. The products were massaged into the affected areas to ensure deep impregnation into the damaged tissues. The utilized oils and ointments were manufactured by different companies using only natural products.

Figure 1.

Group stratification by sex.

Figure 2.

Group stratification by age.

Figure 3.

Burn degree.

Immediately following the initial application of the natural products, a significant reduction in posttraumatic edema was observed across the patient cohort. Pronounced erythema was noted within the first 24 hours, which resolved completely after the second application of the products. Each patient completed a daily survey assessing their sensations and the appearance of their facial wounds. Patients reported a reduction in facial tension, often associated with skin dehydration and the formation of eschars (dead tissue).

Natural oils facilitated better penetration into the eschars, leading to more rapid separation and improved aesthetic outcomes. By the fifth day of treatment, the eschars had reduced by approximately 50%, revealing underlying pink epidermal tissue indicative of healing. By the seventh day, eschar shedding was complete, leaving partial redness in the affected areas. By the fourteenth day, the redness had fully abated, with no pigmentation changes observed in the newly formed epithelium.

Overall, patients experienced complete recovery with satisfactory aesthetic results by day 14. In 45 patients, full epithelization was achieved by day 10, while the remaining five patients required a slightly extended recovery period of over 10 days (Fig. 4). Figs 5–14 illustrate the progression and outcomes of the treatment.

A series of 10 cases pictures is presented.

Figure 4.

Epithelization until day 10.

Figure 5.

A 13-year-old boy with IIAB degree liquid facial burn on days 1, 3, 5, 7, 9, and 11.

Figure 6.

A 5-year-old girl with IIAB degree liquid facial burn on days 1, 3, 6, and 9.

Figure 7.

A 37-year-old woman with IIAB degree steam facial burn on days 1, 3, 6, and 9.

Figure 8.

A 29-year-old woman with IIAB degree chemical facial burn on days 1, 3, 6, and 9.

Figure 9.

A 58-year-old man with IIAB degree flame facial burn on days 1, 3, 5, 7, 10, and 14.

Figure 10.

A 48-year-old woman with I-IIA degree flame facial burn on days 1 to 10.

Figure 11.

A 43-year old man with I-IIA degree steam facial burn on days 1, 2, 3, 5, 7, and 10.

Figure 12.

A 71-year-old man with eschars after steam facial burn on days 1, 2, 3, and 10.

Figure 13.

A 69-year-old man with IIB-III degree flame facial burn on days 1, 5, and 11. Further treatment included surgery.

Figure 14.

A 1-year-old boy with IIAB degree contact facial burn on days 1, 2, 3, 5, 7, and 10.

Burn wound healing is an intricate process involving multiple physiological stages, including inflammation, re-epithelialization, granulation, neovascularization, and wound contraction. The efficacy of various plants in burn wound management is largely attributed to their antimicrobial, anti-inflammatory, antioxidant, collagen synthesis stimulation, and cell proliferative and angiogenic properties.^[6]

It has been estimated that a significant proportion of wound healing agents in traditional medicine, particularly in Ayurvedic practices, are derived from plant sources, with approximately 70% of these remedies being plant-based. Mineral-based remedies constitute around 20%, and the remaining 10% are derived from animal products.^[14]

In the treatment of facial burns, the primary objectives are to achieve recovery with an optimal anatomical balance, restore symmetry, and preserve facial expressiveness. Damage to facial subunits due to tissue injury, traumatic pain, and edema can lead to temporary or permanent disfigurement, contractures, functional loss, and psychological trauma. Effective treatment protocols are essential to mitigate the risk of developing conditions such as microstomia, ectropion, and nasal contractures, as well as to prevent other post-traumatic complications.

Prompt and effective management of burn injuries is crucial, especially for facial burns which pose additional complexities due to potential involvement of the eyes, respiratory system, and nasopharyngeal mucosa. Initial surgical management typically involves the removal of devitalized tissue, the application of corticosteroids, and the use of antiseptic products to reduce infection risks and prepare the wound for further treatment.^[15]

Generally, superficial burns (first and second-degree, I-IIA) are treated conservatively, while deeper burns (second and third-degree, IIB-III) often require surgical intervention. The unique vascularity of the facial region supports rapid healing, which allows for the conservative management of even deep facial burns (IIB) in many cases.^[16]

According to the World Health Organization, over three-quarters of the global population rely on traditional medicine for healthcare needs, underscoring the significance of medicinal plants in primary healthcare, particularly in developing countries.^[17] The process of burn wound healing is complex and mediated by a range of biochemical substances, including antioxidants, cytokines, and various biomarkers.^[18]

The natural products employed in burn wound care exhibit a variety of therapeutic properties, including microbial load reduction, antiseptic, antiviral, anti-inflammatory, and antioxidant effects. They facilitate collagen synthesis, cell proliferation, epithelialization, tissue oxygenation, fibroblast proliferation, contraction, angiogenesis, and dermal reconstitution, making them highly effective in promoting wound healing.^{[19, 20]}

Burn wounds, particularly on the face, exhibit dynamic progression.^[21] Dehydration and infection at the wound site can compromise healing. Therefore, the selection of therapeutic agents is critical to prevent the deterioration of burn injuries and promote effective healing.^[22]

Bletilla striata polysaccharide (BSP) hydrogel has demonstrated excellent performance in absorbing wound fluids and exudates while maintaining a moist environment conducive to wound healing. BSP also functions effectively as a hemostatic agent, supporting the healing process.^[23]

The initial surgical management of facial burns involves the removal of devitalized tissue, application of antiseptic treatments, and use of antimicrobial agents. According to Monafo and West, antimicrobial treatments are beneficial in promoting wound healing and reducing areas of necrosis and stasis.^[24]

Various agents, including silver compounds, antibiotics, antimicrobial ointments, epithelotonic and enzyme-based creams, as well as plant extracts, are utilized in the treatment of facial burns. Amygdalus communis (almond) in a simple ointment base has proven effective in burn treatment, supporting its traditional use in wound care.^[25]

Non-adhesive and pain-reducing products are indicated as they help maintain a moist wound environment. The open approach to wound care, where dressings are left exposed to air, is commonly applied and has gained popularity in clinical practice due to its simplicity and effectiveness.^[26]

The WHO has reported that 70%–95% of the population in developing countries relies on medicinal plants for primary healthcare. Over recent decades, there has been a growing scientific interest in the application of medicinal plants in wound treatment, highlighting their potential in modern therapeutic practices.^[27]

Compared to synthetic agents such as silver sulfadiazine, natural products like Aloe vera have shown superior efficacy in treating second-degree burns, promoting faster and more effective healing.^[18]

Other natural products, such as Arnica and stinging nettle extracts, reduce inflammation and inhibit pro-inflammatory cytokines and metalloproteinases, supporting their use in burn treatment.

Calendula officinalis (marigold) is effective in reducing initial wound edema and is available in various forms such as ointments and creams, which are easy and pain-free to apply.^[28]

Essential oils from tea tree and rosemary have demonstrated substantial wound shrinkage, supporting their use in burn wound care.^[29] Additionally, ointments containing sesame oil, camphor, and honey have shown significant wound healing activity reducing the wound surface area and promoting faster recovery.^[30]

Natural products are believed to enhance epithelization and prevent severe scar formation due to their anti-inflammatory and antioxidant properties.

The anti-inflammatory effects of Curcuma (turmeric) are attributed to its ability to inhibit histamine production and extend the action of cortisol, a natural anti-inflammatory hormone. Curcumin, the active compound in turmeric, also exhibits potent antiviral properties, particularly against herpes simplex virus types 1 and 2.^[31]

Enzymatic necrectomy, preferred over traditional escharectomy and skin grafting, utilizes plant-derived enzymes to penetrate eschars and facilitate their separation from healthy tissue. This method allows for better tolerance and reduced antigenic effects.^[32]

Aloe vera , olive oil, and shea butter are particularly effective against scar formation by reducing inflammation and promoting organized collagen deposition. Bletilla striata, a member of the Orchidaceae family, stimulates granulation tissue proliferation and repair, supporting its use in burn treatment.^[33]

The use of enzymatic agents for necrectomy, which penetrate but do not separate eschars from wound beds, enables good sub-eschar epithelization and gradual eschar reduction, promoting faster and more effective wound healing.^[34]

De Campos et al. demonstrated that a biofilm impregnated with Casearia sylvestris extract significantly enhanced healing in a rat burn model, supporting its potential therapeutic benefits for second-degree burns.^[35]

In summary, the use of natural products in burn wound treatment facilitates early resolution of acute inflammation, better infection control, and faster healing, making them a valuable addition to burn care protocols.

Based on the evidence collected, the outcomes of using natural products for burn treatment are considered highly favorable, with significant improvements in healing times and aesthetic results.

For the treatment of all patients included in the study, we have used a combination of two products manufactured by different companies. The first product is an oil containing butyrum, skin lipids, Pyrus malus fruit extract, Stellarioides longibracteata leaf extract and tocopherol. The other one is an unguent with Sesamum indicum seed oil as the main ingredient, combined with beewax, Phellodendron chinense bark extract, Scutellaria baicalensis root extract and Coptis chinensis Rhizome extract.

The application of these herbal products in the treatment of burns, difficult-to-heal wounds, hematomas, edemas, and post-surgical recovery has proven to be highly effective. Our study demonstrates that these products can be successfully used in managing superficial facial wounds with excellent outcomes.

All the plants discussed in this review exhibit potent antioxidant, anti-inflammatory, and antimicrobial activities, which enhance wound hydration, promote the liquefaction of devitalized tissue, and reduce fibrin deposits. These properties contribute to the expulsion of necrotic tissue, diminish bacterial invasion, and alleviate underlying inflammation.

The resulting epithelization forms a supportive matrix that promotes fibroblast and endothelial cell migration and proliferation. Newly formed granulation tissue progressively fills the wound bed with healthy tissue, stimulating complete epithelization.

Negative sides of this method that we can acknowledge are the longer course of treatment, which is also only applicable for superficial burns.

The favorable results observed in our study provide a strong basis for recommending the use of natural products in the treatment of superficial facial wounds, adhering to a strict treatment protocol to ensure optimal outcomes.