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Efficacy of MEBT/MEBO in the Rehabilitation of Hyper-pigmentation after Facial Burn Injuries
Add Timeú║2011/6/14 15:54:59
Wang Guang-shun  Li Cheng-cun
Affiliation: Affiliated Hospital of Taishan Medical College   Shandong province   271000
 [Abstract] Objective: To explore therapeutic approach to promote the rehabilitation of pigmentation after facial burn injuries. Methods: 194 cases with pigmentation facial burn injuries admitted from Mar 2000 to Mar 2004 in our burn unit were randomly grouped into test group (98 cases) and control group (96 cases). In test group, patients were managed by ways of MEBT/MEBO, performing dressing-change with MEBO Wound ointment once every other day, ten times of dressing-change as one course of treatment. During the course of treatment, MEBO Scar Ointment was intermittently administered twice in the morning and before bedtime. For the mild cases, it only needs one course of treatment; for the severe cases, 2 to 3 courses of treatment had been given; in control group, the patients were applied MEBO Wound Ointment and MEBO Scar Ointment by themselves at home according to the instructions. Results: In test group, 90 cases (91.84) were cured, 8 cases (8.16%) got improvement. The affected area with pigmentation had the sensation of flushing; in control group, there had no cured case, 78 improved (81.25%), 18 (18.75%) without effects. The sign of local flushing was not obvious. Conclusion: MEBT/MEBO is an ideal approach in the prevention and treatment of pigmentation after facial burn injuries. It has positive significance to increase the patientsí» confident and improve the life quality.
[Key words] Facial burn injuries; Pigmentation; MEBO Wound Ointment; MEBO Scar Ointment
I. Material and methods
i. Clinical material: From Mar 2000 to Mar 2004, 194 cases (male 106 cases, female 88 cases) with pigmentation after facial burn injuries admitted in our department were applied MEBT/MEBOú█ú▒úŢ, satisfactory efficacy was gained that improved the patientsí» life quality. All study objects were cases with pigmentation after facial burn injuries with average age of 22í└7.8 (16 years old to 28 years old). During the early stage of interventions, a variety of therapeutic approaches were chosen. Those lack of documentation or cancelled during the follow-up or could be connected were excluded in the two groups. Those with chronic diseases and performed eschectomy were also excluded in order not to impact therapeutic effects. Study objects included 116 cases with heat burn injuries, 46 chemical burn injuries and 32 electrical burn injuries. 76 cases with deep II degree burns superficial type, 84 cases with deep II degree burns deep type, 34 cases with the compound burns of deep II degree and III degree. The location of burn injuries: mainly on head. The range of TBSA of pigmentation after burn injuries was from 2% to 7%. Clinical manifestations: mild: pale brown 48 cases (takes up to 24.7%); moderate: dark brown 112 cases (takes up to 57.73%); severe: tan 34 cases (takes up to 17.53%).
ii. Methods: Randomly divided cases into two groups: test group (98 cases) and control group (96 cases). The medications used in both groups: MEBO Wound Ointment and MEBO Scar Ointment. All medical practice was implemented by the same doctor or nurse. For the cases in control group, MEBO Wound Ointment was given by themselves according to the direction after discharge. Both groups were tested under the same diagnosis and medications. Only the procedures and the ones topping up medications were different. Therefore, it is of the comparability.
iii. Procedures: Firstly, cleaned the face with warm water, and then intermittently rinsed with 38íŠíź40íŠ water and provided warm and damp pad for 20 minutes. After padding the affected area to dry,, applied MEBO Wound Ointment in line with the use of common cosmetics. And then performed the circle massage with pulp for 15 minutes and wiped the remnant ointment off with absorbent cotton. Subsequently, MEBO Scar Ointment was administered as the same way and the affected area was massaged according to the direction of skin texture from periocular area, facial and buccal area, forehead to neck sequently. The treatment was given every other day, ten days as one course of treatment. For the mild case, one course of treatment was given. Two or three courses of treatment were given to the severe ones. During intermittent periods, MEBO Scar Ointment was continuously given on the affected area twice a day, in the morning and before the bedtime.
iv. Criteria for evaluation: ó┘ healed: the previous pigmentations are completely disappeared. The patients are satisfactory. ó┌improved: the previous pigmentation becomes shallow, from tan to dark brown or shallow brown. The patients are basically satisfactory. ó█No effects: no changes on pigmentation.
II. Results
Warmness on affected area and slight redness in both groups are taken as the evidence of microcirculation improvement. Microcirculations in test group were apparently improved; there was no obvious changes in control group. That indicates that this therapeutic protocol could improve the microcirculation of pigmented area after burn injuries. Besides, there were no side effects during the whole treatment, such as blister, skin breakdown and infection.
In test group, 90 cases (91.84%) were healed; 6 cases (8.16%) were improved. For mild cases, 28 (28.57%) were healed within one course of treatment; for moderate cases, 46 (46.94%) were healed within two courses of treatment; two cases (2.04%) were improved; for severe cases, 16 (16.33%) were healed within 2 to 3 courses of treatment; 6 (6.12%) were improved. In control group, 78 cases (81.25%) were improved; 18 cases (18.7%) had no effects. All of the above therapeutic periods were calibrated according to courses of treatment in test group. The curative rates compared between two groups had significant difference, P<0.01.
III. Discussion
Hyperpigmentation after facial burn injuries not only takes impact on the appearance, but also brings psychological stress in patients, in particular the unmarried people with great distress who eager to the treatment. That has become the protruding problems in the entire progress of burn treatment. The traditional interventions include the physical methods in combination with relevant medications. But the therapeutic results are often unsatisfactory. With the standardization and development of the marketing economic, victims suffered from burn injuries would pay much more concerns on the recovery of late-phrase appearance during rehabilitation period, not only on the wound healing. Therefore, MEBT/MEBO in the treatment of rehabilitative periods after burn injuries can promote the recovery of patientí»s appearance and improve life quality.  
The mechanism of hyper-pigmentation after burn injuries is unclear. But the general conception is the disturbance of the production of melanin transferred from tyrosine that results in the increased amounts of melanin. The current point believes that the possible factors might be the disturbance of skin blood circulation, the decreased reduction of Dopaquinone and hyperpigmentation caused by spot pigment cells. Jiang Yanú█ú▓úŢfound from the observation in the micro-circulation of hyper-pigmented skin that the features different from normal skin micro-circulation includes decreased number of vascular loops in the hyper-pigmented area, vague vascular loops, dark redness of blood color and micro-circulation disturbance at different degrees. Therefore, the presumed theoretical mechanisms indicate during the rehabilitation therapy: on one hand, micro-circulation should be improved, providing sufficient nutrients; on the other hand, the metabolism of skin melanin should be promoted in order to eliminate the hyper-pigmentation. In clinical observations, hyper-pigmentation after burn injuries occurs most obvious within one to two weeks after wound healing. Therefore, the first time to carry out implementation should be within 3 to 5 days after wound healing that the optimal effects could be gained. For the ones with hyper-pigmentation for more than half year, the therapeutic effects would be poor that might be related to the over-excessive sun exposure. The formation of melanin happens in melanocytes that are able to synthetize tyrosinase. Under the action of tyrosinase, tyrosine is gradually oxidized into dopa and dopaquinone that will rearrange and be polymerized and ultimately combined with proteins into melanin protein. Therefore, melanin is compact high polymer with fundamental structure of indole and quinone in combination with proteins. It needs four weeks for the normal skin to restore its original luster after ageing and shedding. Patients with burn injuries often have excessive energy leading to fatigue that can induce the failure of normal metabolism of skin keratin. Moreover, due to the metabolic imbalance of newly grown skin cells, it needs to carry out the rehabilitation therapy every other day. During the intermittent periods, it is better to use MEBO Scar Ointment either. The extension of hyper-pigmentation and skin rehabilitation has direct relationship with burn depth. The hyper-pigmentation of deep II degree burns superficial type is mild. It can be restored after one course of rehabilitative treatment. Hyper-pigmentation after deep II degree burns and compound burn injuries is severe with long-term rehabilitation periods and sluggish recovery process (generally needs 2 to 3 courses of treatment). Compared between two groups, the healing time of control group was apparently extended. But the detailed extension time has not been given the statistic study and the relevant mechanism is waiting for further research.
In rehabilitative protocol of MEBT/MEBO, the sole face-rinse with warm water has no effects of decreasing pigmentation, but it can warm the affected skin, relieve the skin tightness and open the orifice of skin appendages, all of which can remove the unnecessary lipoids and necrotic cells and maintain the patent hair pore by cleaning up dust and dirt. The external application of MEBO Wound Ointment can produce the effects of promoting blood circulation and removing blood stasis and nutrition. With the use of massage, the effects of moisturization, nutrition, softening of capillaries, extension and elimination of emboli, promotion of venous reflow, acceleration of circulation and metabolism, facilitating the secretion of sweat glands and sebaceous glands and promotion of fading hyper-pigmentation. The use of MEBO Scar Ointment in association of massage therapy can promote the absorption of nutrients, activation of cells, improvement of cell membrane permeability, reduction of tyrosinase activity and fading of pigmentation. During the intermittent periods, associated use of MEBO Scar Ointment has sunscreen effect to avoid the aggravation of hyper-pigmentation. It is predicted from the clinical efficacy that the comprehensive effects of this rehabilitative protocol could break down the inner membrane of pigment cell and stop the formation of hyper-pigmentation. With the esterification of MEBO Wound Ointment permeating into the pigmented area, the restoration of dopaquinone will be increased and the production of melanin will be decreased during the process of pigment metabolism. By the action of metabolism, pigmentation will be promoted to fade.
Prior to the implementation of this rehabilitative protocol, corresponding basic knowledge should be introduced to the patients that is necessary to eliminate the patientí»s urgency seeking interventions and avoid irritable emotion. It should make patients understand that the length of pigmentation therapy is associated with the continuity of rehabilitative therapy. The patients should be noted that patience and compliance with the standard therapy are obligatory so that the confidence will be built up and optimal clinical effects will be gained. The is rehabilitative protocol is the ideal method with simple practice in the treatment of hyper-pigmentation after burn injuries without pain and side effects facilitating to be popularized. The perfect effects gained from this rehabilitative protocol will greatly maintain the patientí»s compliance.  
ú█1úŢ Xu Rong-xiang. The Study Report of Tissue Organ in situ Regenerative Restoration [M]. Chinese Medical and Scientific Press, Beijing: 2002, 94-96.
ú█ú▓úŢ Jiang Yan. Practice of Ultrasonic Wave in Treating Pigmentation and Observation Report of Skin Microcirculation. Wuhan; Medical Cosmetics (internal material). 1990, 95-96.
ú█3úŢ Yang Guo-liang, Wang Xia-sheng. Modern Dermatology [M]. First Edition, Shanghai: Shanghai Scientific and Technological University Press, 1998, 645-646.
ú█Authorsí» introductionúŢ
Wang Guang-shun (1949-), Male, (Ethnic Han), born in Taií»an, Shandong province, graduated from Shandong Medical College in July 1974, tutor of master degree candidate, medical professor.
Li Cheng-cun (1968-), Male, (Ethnic Han), born in Taií»an, Shandong province, graduated from Taishang Medical University in July 1994, attending doctor.
 (paper received on Jun 10th, 2004)
 (Published in The Chinese Journal of Burns Wounds & Surface Ulcers 2005, volume. 17. No. 1)

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