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

Wounds. 2001;13(4) 

In This Article

Introduction of Tannic Acid as a Topical Agent in Burn Treatment

Incidental accounts on the use of tannins and tannin-containing plants can be found here and there in the history of burn treatment. However, it is Davidson[5] who deserves the credit for introducing the tannic acid method of treatment that became the standard therapy for burn patients in subsequent years. It is his contribution to have developed one of the first therapies that significantly improved the treatment of thermal injury. The rationale behind Davidson's work was found in the toxin theory, one of the many theories that had by then evolved to explain the diverse pathophysiological phenomena observed in burn patients. This theory attributed the systemic reactions seen in these patients to the absorption of some toxic substance from the affected skin. It was, at that time, prevalent and most strongly supported by experimental evidence. Thus, already in 1905, Pfeifer[17] had reported the presence of a labile neurotoxic substance in the urine and serum of experimentally burned mice. This toxin was also found to induce necrosis of internal organs, in particular those of the gastrointestinal tract. Pfeiffer's observations were confirmed by many others, perhaps most convincingly by Robertson and Boyd in 1923.[18] These investigators grafted burned skin onto normal animals, which showed toxic manifestations within short notice. Likewise, injection of blood from burned animals into controls resulted in toxic effects in the latter. They isolated and characterized the toxin and found it to be composed of autolytic products of decomposed proteins. These experiments convinced Davidson of the necessity to prevent resorption of burn toxins into the circulation. To accomplish this objective, he used tannic acid, since it has the property to complex with all kinds of biomolecules and therefore "might be efficacious in precipitating poisonous materials in burned tissue."[5]

In his first publication on the subject, Davidson reviewed 25 case histories of burn patients treated with tannic acid. After some initial experiments with unfavorable outcomes in which he applied boric acid compresses to the tanned eschar in an attempt to remove it, Davidson successfully employed the open treatment method. Upon admission of the patient to the hospital, the burn wounds were dressed with sterile gauze and bandages and moistened with freshly prepared 2.5- to 5-percent aqueous solutions of tannic acid. The dressings were kept wet until a satisfactory coagulum had been formed, and the wounds had become insensitive to pain. At that moment, they were removed, and the burns were exposed to air. In few cases, in particular in facial burns, a 5-percent ointment with a petrolatum and lanolin base was used instead of the aqueous solutions.

In Davidson's experience, tannic acid was best suitable in the management of burns. It was superior to other therapeutic regimens, since it notably reduced the degree of toxemia as determined from clinical and physico-chemical observations and the lowered mortality rate. Tannic acid was also found to be advantageous in several other respects. The local protein-precipitating effects of tannic acid include relieving the pain, preventing the loss of plasma, and markedly limiting secondary infection. Furthermore, in nonfatal cases, a diminution in the amount of scar tissue formation was observed. This was believed to be an additional effect of the formed coagulum, which could provide "a scaffold for the growth of the young epithelial cells over the denuded surface."[5]

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