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Burns are an important medical problem that can be associated with irreparable physical and mental injuries and eventually death. Due to the damage caused by the burn to the body’s defense barrier (skin) against external factors; Wound infection is one of the most important problems that the injured person faces. Burns are graded based on the depth of skin tissue that develops necrosis. In grade I burns, the lesion is confined to the epidermis. In grade II burns, the depth of the burn extends to the dermis but the subcutaneous adipose tissue is not involved. Grade II burns are divided into superficial and deep. The main characteristic of grade II superficial burns is blistering and fluid accumulation on the surface between the epidermis and dermis, which usually occurs several hours after the burn. In grade II deep burns, the deep layers of the dermis also become necrotic, which is accompanied by severe scarring due to complete loss of the dermis layer. In grade III burns, the depth of necrosis passes through the dermis layer and enters the subcutaneous fat layer. In grade IV burns, the depth of necrosis also spreads to subcutaneous tissues such as muscles and bones.

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Stages of healing include homeostasis, inflammation, proliferation, and reshaping. In vitro, aloe inhibits thromboxane (an inhibitor of wound healing). The enzymes in aloe break down damaged tissues and these tissues are removed by phagocytosis. In vitro, a glycoprotein component of aloe enhances the proliferation of human keratinocytes and the expression of receptors for Epidermal Growth Factor and fibronectin. It was later found that this glycoprotein also increases wound healing in vivo by increasing cell proliferation. In vivo, beta-sitosterol accelerates wound healing by stimulating angiogenesis and neovascularization. Aloe vera also promotes healing in vivo and reduces inflammation in grade II burns. In a study of 72 burn patients with a relative thickness compared to the control group who used Vaseline, topical aloe vera gel significantly increased the healing rate and the average healing time for the aloe vera gel group was 11.89 days. And in the control group it was 18/18 days. Complete epithelialization occurred after 14 days in the aloe vera group. In a study of 18 outpatients with moderate to profound grade II burns with a range of involvement of 2 to 12% of total body surface area; Aloe vera ointment was as effective as silver sulfadiazine (SSD) in protecting against bacterial colonization and healing time.

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The average healing time with aloe vera was 13 days and for SSD it was 16.15 days. In vitro, aloe vera has been effective against a wide range of bacteria, including Pseudomonas aeruginosa, Streptococcus pyogenes and Staphylococcus aureus. Numerous in vitro findings have shown that lavender essential oil has antibacterial and antifungal effects. Lavender essential oil has also been shown to have a good effect on gram-negative bacteria and to some extent covers Pseudomonas strains. Topical application of lavender essential oil has rubefacient properties and seems to have analgesic, anti-allergic and anti-inflammatory effects.

Geranium essential oil is an antidepressant and antiseptic, a valuable astringent and a hemostatic (bleeding stopper) and promotes rapid healing, which makes it very useful for treating wounds. In addition, Ecoli, Staphylococcus aureus and Pseudomonas aeruginosa are important strains against which geranium is effective.

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In a randomized double-blind clinical trial; 111 patients with grade II superficial burns used Lagex Burn Cream or Silver Sulfadiazine SSD (1%) once a day for 2 weeks. In each patient after careful debridement and cleaning of burn wounds with a suitable antimicrobial solution (chlorhexidine 0.25%); Using a sterile spatula, apply about 5 grams of cream per 10 cm2 of the burn area on the wound. The wound was then covered with sterile gauze and bandaged. Treatment was continued once daily until the wound was completely healed. Patients were evaluated for pain or burning and itching before the first 24 hours, the first 48 hours, the first week and two weeks after treatment. Based on the results of this study; The effect of Lagex burn cream in reducing pain or burning during different periods was significantly greater than SSD. There was no significant difference between the two groups in terms of the effect on pruritus. (P> 0.1) Only one of the subjects (0.9%) in the Lagex group had an infection that improved with continued treatment. The dryness of the wound area on the second day after treatment was significantly lower in the Lagex group than in the SSD group. The rate of complete recovery in the two groups reached 90.9% after 7 days and reached 100% after 14 days and no statistically significant difference was observed between the two groups. (P = 0.52).
The researchers concluded that due to the complication of SSD in partially inhibiting epithelialization and leaving black spots in the wound area, Lagex can be a good alternative to silver sulfadiazine in preventing infection while reducing the severity of pain and dryness in the burn area.

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