The role of alternative therapy in the management of partial thickness burns of the face--experience with the use of moist exposed burn ointment (MEBO) compared with silver sulphadiazine

Introduction Moist exposed burn ointment (MEBO) is an example of an alternative remedy proposed in the management of burn injuries. Developed in the late 1980s at the China National Science and Technology Centre in Beijing with its clinical use reported originally from China, MEBO is a petrolatum-based ointment containing sesame oil, β -sitosterol, berberine and other plant ingredients. The precise mechanism of action is nit fully understood but it is surmised that the oil-based ointment provides a moist environment encouraging epithelial regeneration; moreover, β -sitosterol provides some anti-inflammatory effects. The absence of dermal irritation or sensitisation of MEBO when applied cutaneously has been previously established. Proponents of MEBO claim that it encourages burn wounds regardless of depth or extent to heal and regenerate spontaneously without surgical intervention. This is in contrast to the current conventional approach that advocates early excision and grafting of deep burn wounds with the use of antibiotic creams like silver sulphadiazine and sulphamylon as local wound therapy. In addition, MEBO is claimed to have analgesic properties and an anti-bacterial effect, and prevent scarring and contractures even in unoperated deep dermal partial thickness burns. We embarked on a single-centre prospective randomised controlled clinical trial to verify these claim with respect to MEBO as compared with our current Burn Centre management in patients with partial thickness burns. Parameters studied included the rate of wound healing, anti-bacterial effect, analgesic effect, subsequent scar development and the hospital resource costs. The results of this trial will be reported elsewhere. We present here our experience with MEBO in the management of partial thickness burns of the face. Facial burns are common and account for up to a quarter of admissions to the Singapore National Burns Centre, either in isolation or as part of a more extensive burn injury. Deep facial burns result in scarring and contracture with deleterious effects on vital facial structures like the eyelids and lips. The majority of facial burns, however, are partial thickness in nature and respond to conservative management. The goal of this therapy is to provide an environment for healing of facial skin with limitation of zone of injury and bacterial infection, and with minimum scarring and pigmentation change. Ideally, the treatment should be pain free and easily administered by the nursing staff, and the progress of healing easily monitored. Hitherto, the conservative management of facial burns includes application of aureomycin cream and spenco dressing for superficial partial thickness burns, with silver sulphadiazine cream for deeper partial thickness burns. Surgical excision and grafting are reserved for full thickness burns to prevent lid or lip ectropion. In this study, we report our experience with MEBO compared with silver sulphadiazine in the management