The Use of Tannic Acid in the Local Treatment of Burn Wounds: Intriguing Old and New Perspectives

Wounds. 2001;13(4) 

In This Article

Abstract and Introduction

The use of tannic acid in the local treatment of burns is controversial. Although it became the therapy of choice shortly after its introduction in 1925 and most clinicians agreed upon its effectiveness, the tanning method was generally abandoned again halfway through the forties, as hepatotoxic effects were observed in both patients and experimental animals. However, a critical evaluation of early literature data shows that hepatic necrosis and impairment of liver function were not exclusively related to tannic acid treatment but also occurred in patients who were treated otherwise. Moreover, in those studies reporting adverse effects, tannic acid preparations of ill definition and poor quality were used often in extremely high concentrations. More recently, it has also become apparent that native pathophysiological phenomena, rather than tannic acid intoxication, underlie the liver damage seen in thermal injury. In this perspective, it is not surprising that the use of tannic acid as an adjuvant therapy for burn wounds has regained interest in present times. In particular, some preclinical and clinical studies indicate that highly purified tannic acids can provide a valuable tool to improve wound healing and to reduce scar tissue formation.

A whole array of remedies has served in the local treatment of burns through the ages. In ancient Chinese texts, many decoctions of medicinal herbs were advocated for the "dispersal of heat and detoxication" of "fire poison."[1] Similarly, the Ayurveda contains references to the topical application to burn wounds of vegetable oils, powdered plant materials, honey, or mixtures thereof.[2] In his presidential address at the annual meeting of the American Burn Association in 1971, Moncrief[3] presented an overview of the developments in topical treatment of burns in the Western world. On this occasion, he recounted some noteworthy early milestones, such as: Hippocrates' recommendation to use swine's fat; the introduction in the 18th century of "Carron oil," a popular therapeutic containing linseed oil and lime water that continued to be used for over 200 years; and the appearance of boric lint and medicated paraffin at the end of the 19th and the beginning of the 20th century. Furthermore, Moncrief mentioned some recent progressions in this field through chemical escharotics and antibiotic agents, such as the aniline dyes, sulfonamide drugs, and penicillin, to eventually the adoption in burn therapy of silver sulfadiazine. The latter compound, together with cerium nitrate, which became available some years later,[4] has remained the topical treatment of choice until now.

The availability of increasingly adequate local therapeutics, in addition to advances in general care of burn patients and improved surgical techniques, have resulted in a gradual decrease of mortality due to burns. The work of Davidson[5] in the 1920s laid the foundation for this development, as it revolutionized the attitude of the medical profession toward the treatment of burns and was the impetus for further research in this field. He was one of the first who took pity on extensively burned patients and showed that their terrible suffering may be alleviated by better local therapeutic regimens, such as his tannic acid method of treatment. This method, which became immensely popular shortly after its introduction and has recently experienced a revival in interest, is the subject of this paper. The original method applied by Davidson as well as all later modifications will be reviewed. The arguments for and against the use of tannic acid, but in particular its alleged hepatotoxic effects, will also be elaborated upon and put in a historical perspective.

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