A rare scrotal burn from post-circumcision cetrimide-chlorhexidine (savlon) dressing: Case report and literature review.

Abstract

Introduction: Scrotal burns resulting from wound care are a rare but preventable injury compared to the wide spectrum of post-circumcisions related complications documented. We report an inadvertent cetrimide-chlorhexidine antiseptic scrotal burns due to post-circumcision dressing and review the literature on genital chemical burns.

Case presentation: A 6-week-old baby presented with a 3-days history of worsening scrotal burns following smearing of undiluted cetrimide-chlorhexidine as dressing post-circumcision. Examination revealed a healthy baby with non-tender non-specific multiple ulcers and pan-erythematous scrotum. Wound swab isolated Klebsiella and Pseudomonas spp.

Discussions: Although there was no clinical complication during procedure, the wrongful post-operative care resulted in scrotal burns. The isolated uropathogens did not result in sepsis or Fournier's gangrene, we believe this preventable burn was eventually reported due to the worsening progression over the period, albeit with minor adverse effects.

Conclusion: Post-circumcision instruction for cetrimide-chlorhexidine use by caregiver must be understood to avoid scrotal burns.

Lay summary: Scrotal skin burns from chemical agent: Isolated scrotal skin burns are not common and even rarer when they are caused by prescribed medical solution. A neonate was brought in by the parents with complain of developing watery containing swellings on the scrotum that later bust and leads to peeling of the scrotal skin. The mother noticed this after applying dressing solution as part of the measures to prevent circumcision wound infection. Even though the child looked well, the large scrotal surface without skin cover could become a common point for bacteria entry into the body and its consequences. Even though our test isolated 2 different types of disease-causing bacteria from the scrotal wound, this child was managed well and the wounds healed without any further problem. The lessons: 1. circumcision is the commonest surgical procedure performed. 2. This incidence may only be the tip of the iceberg. 3. The parents brought him because it was getting worse. 4. It is a preventable injury by just using the agent in accordance with recommendations.