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Three Part Question

In [patients with acute burns] is [potato peel dressing better than gauze or cloth alone] at [promoting healing and preventing infection]?

Clinical Scenario

During a camp trip in a remote area, a 32-year-old man has burned his hand and arm in the camp fire. As he had neither a first aid kit nor bandages or dressings to cover the wounds, he used cooked potato peels for this purpose. When you see him some time later in the emergency department you are very impressed by his innovative use of vegetables, though somewhat less sure of their efficacy and safety in burns. Before you dismiss the idea completely, however, you wonder if there is any published evidence.

Search Strategy

Medline 1966–2008/09 using the Pubmed interface: (“Burns” [Mesh] OR Burn* [TW]) AND (“Bandages” [Mesh] OR “dressing” [TW]) AND “potato” [TW] LIMITS to English. Ovid MEDLINE(R) 1950 to September week 4 2009: Exp Burns/AND exp Solanum tuberosum/OR potato.mp.
Embase via the NLH interface 1980–30 September 2009: exp BURN/OR exp potato/OR potato.mp.

The Cochrane Library, Issue 3, 2009: MeSH descriptor Burns explode all trees AND MeSH descriptor Solanum tuberosum explode all trees OR potato, ti, ab, kw.

Search Outcome

Nineteen papers were found of which 16 were irrelevant or of insufficient quality. Details of the three remaining papers are shown in the table

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Gore and Akolekar, 2003, India	30 patients aged <40 years with a burn size <50% of body surface area.Gauze with potato peel vs gauze with banana leaf. Potato peel applied to the left side and banana leaf dressing to the right.	Cross over trial	Days until complete epithelialisation	No significant difference	No statistics performed; blinding is not clear; no control group (crossover trial).
			Eschar formation	No significant difference
			Number of areas requiring skin grafting	No significant difference
			Pain	No significant difference
			Patient comfort	No significant difference
			Dressing handling	No significant difference
Subrahmanyam et al, 1996, India	100 patients with partial thickness burns over <40% of body surface area treated within 6 h.Potato peel vs honey.	Randomised controlled trial	Days for complete healing	16.2 vs 10.2 days (p<0.001).	Randomisation not clear; blinding not reported.
			Persistant infection at day 7	10% vs 100% (p<0.001).
			Adverse effects	There were no adverse effects in either of the groups.
			Subjective relief of pain	No significant difference
Keswani et al, 1990, UK	17 hospital patients aged 1.5–45 years with burns between 5% and 42% of body surface area (mean 18.6%).Gauze with potato peel vs gauze alone in similar burns on each patient.All patients had silver sulfadiazine applied below the dressing.	Clinical trial	Bacterial growth	No difference in bacterial growth	Much of the data here is histological; there are no patient outcomes.No statistics performed. Blinding and follow-up are not clear.
			Epidermal regeneration	epithelial regeneration in potato peel dressings.
			Formation of exudates	Prevention of dessication in potato peel dressings.
			Survival of superficial skin cells	Increased survival of superficial skin cells in potato peel dressings.

Comment(s)

The evidence presented is all from burns units in areas of the world where skin homographs and xenographs are rarely available and is therefore not directly applicable to settings in which such grafts are common. Furthermore, all the studies use sterile potato peel dressings, not rough cut potato peel as set out in the clinical scenario. The value of potato peel seems to be in reducing desiccation and thereby promoting healing during the burns unit phase; there is little evidence of independent antibacterial effect.

Clinical Bottom Line

There is no evidence to suggest that potato peel is effective as a burns dressing in the acute phase. Sterile potato peel dressings are better than gauze alone during the healing phase.

References

1. Gore MA, Akolekar D. Evaluation of banana leaf dressing for partial thickness burn wounds. Burns 2003 Aug;29(5):487-92.
2. Subrahmanyam M. Honey dressing versus boiled potato peel in the treatment of burns: a prospective randomized study Burns 1996 Sep;22(6):491-3.
3. Keswani MH, Vartak AM, Patil A et al. Histological and bacteriological studies of burn wounds treated with boiled potato peel dressings. Burns 1990 Apr;16(2):137-43.