A skin burn from culinary mustard

We present the management of a patient who presented to our unit following naturopathic treatment for osteoarthritis. The patient in question was a 77-year-old female who had been recently advised by a non-clinician that ginger was an excellent treatment for arthritis if used as a poultice and regularly applied for 1 h. After a loss of faith with conventional arthritic therapies and her usual analgesia, the patient prepared the poultice using a mixture of ginger powder and cold water. After applying the poultice, she suffered increasing pain from the area for 30 min, and after 1 h found the agent intolerable. She noticed, on removing the application, that the skin had partial thickness burns. No first aid was administered. She realised on checking the ginger that in her confusion she used a well-known brand of strong English mustard. The patient presented to our unit 5 days following the application. On examination, there was a tender 10 cm diameter partial thickness burn to the right knee. This was of normal pH. Following irrigation, the burn was dressed with non-adherent dressings and reviewed after 1 week. At this point, the burn had healed with no scarring or altered pigmentation. Chemical burns are common place in many burns units and comprise 13% of domestic burns in the UK [1]. The cornerstone of all chemical burn management is prevention involving education regarding the caustic nature of domestic goods, proper handling, adequate protection and copious irrigation [2]. The accepted treatment of such burns is with dilution using saline or a buffer solution and if unsuccessful excision and grafting of the burn [2]. The caustic effect and management of sulphur mustard burns is well documented [3,4]. The only previous documented case of a culinary mustard burn in the literature was as a naturopathic remedy for pneumonia, the compression being applied to the mid-chest and medial breast. This gave a partial thickness burn causing