Cat Scratch Fever: Clinical Pearls for Wound & Scar Therapy

so I got into an altercation with my cat this week and wound up with some serious scratches on the eye area of my face. I was concerned about scarring, so i did some research and polled colleagues on their favorite remedies. The following is a compilation of the collective wisdom generously shared:

When the cat scratched my face (he landed on my head after falling) i had blood running down my face. my first imperative was to stop the bleeding. I keep a Chinese patent remedy, called Yun Nan Bai Yao in my medicine cabinet. It's an invaluable first aid to stop bleeding, and it works. Application method: apply the powder with gauze or cotton to the wound, and apply pressure. The herbs cause the blood to quickly coagulate. Add more as necessary until the bleeding stops. It won't take too long, unless it is a deep cut. The Vietcong famously carried Yun Nan Bai Yao with them in Vietnam to treat gunshot wounds because it does the job well. Once the bleeding has stopped you can bandage it up.

After i stopped the bleeding i thought i would leave it and let it rest. I had to go into the clinic, so i flew off a quick plea for help from colleagues and went on my way.

Later that evening i read through the wonderful advice offered. the first thing i learned is that conventional wisdom on wound healing has changed. You may remember the old school advice that says to leave the wounds open to the air to breath once the scab has formed, especially at night. Western medicine has changed is opinion on this, and have found that wounds heal faster if they are kept covered so that they remain moist and juicy. The scabs will produce scars.

Chris Macie writes:

From recent science, as well as tradition, keep open wounds covered, and juicy (as if internal, swimming in nourishment that repairs). Let the dressing plus the medium (be it Res-K or other TCM or traditional herbal, or modern bio-synthetic compounds) take the place of the scab!

The "science" -- couple of years ago, NY-Times Science section, Q&A dept: Question: better to leave wounds open to heal? (Or my Polish grandmother's advice: let wounds breath (open) at night). Answer: NO. Keep covered and in a healing, moist environment. Periodically cleaning and redressing, of course.

This makes sense from a TCM (Traditional Chinese Medicine) perspective. In TCM, we want to prevent stagnation. the scars are a result of Qi and Blood stagnation in the tissues. Keeping the wound moist allows for blood circulation, including the white blood cells and phagocytes to stop infections, and the various biochemicals and proteins needed to stimulate collagen and tissue regeneration. Scabs are dead blood due to blood stagnation. so it makes sense that although they provide a natural band aid to protect an open wound from infection, the stagnation would slow healing and promote the formation of scar tissue.

As the cat's claws were likely dirty, i cleaned the wounds with a mild soap and water solution, removing the scabs. Contrary to popular belief, and according to Medscape, studies do not demonstrate that hydrogen peroxide inhibits bacterial growth. So being as it stings like a #!?#@!, there is no longer a compelling reason to use it to disinfect wounds, though the bubbling action is helpful to loosen dirt and gravel.

An alumnae i interned with at PCOM (Pacific College of Oriental Medicine) Andrea Beth Damsky recalled receiving these directions from a hospital:

Keep the wound moist with Aquaphor or Vaseline. Do NOT use antibiotic ointments or creams such as neosporin because these increase the possibility of an allergic skin reaction. The purpose of the Aquaphor or Vaseline is to keep the wound moist and prevent scabbing, because moisture speeds healing of the skin and scabbing (contrary to popular wisdom) increases the likelihood of tearing the skin and creating scars. Keep the wound(s) covered. Remove the bandages daily, wash gently to remove any crusting or scabbing, reapply Aquaphor or Vaseline; repeat every day until the skin has healed.

I would add, avoid much exposure to sun or wind until your skin has healed, and any exercises that would stretch the skin of your face.

I imagine you are resistant to bandage your face... perhaps it would work just as well to apply the Aquaphor/Vaseline several times daily in lieu of using a bandage?

You could use vitamin E or other oils once the skin has healed over.

Regarding nursing care, Denise Moran of Center for Rejuvenation Acupuncture, with 20 years experience working for plastic surgeons and dealing with wound healing, advises:

If you live in a sunny area and are out in the sun more than 5-10 minutes, you want to be sure the wounds are covered as the sun exposure could permanently pigment the scars. The bad news is that all wounds heal with a scar, the GOOD news is that the face is very vascular and the thinnest skin on our body and heals better than anywhere else.

I don't like to use vasoline because its a petroleum product. Several practitioners suggested Ching Wan Hung burn ointment to prevent scarring. I keep this item in the medicine cabinet, beside the Yun Nan Bai Yao and my Flying Dragon Liniment. Its wonderful for kitchen burns. It contains many blood moving herbs with heat clearing properties, which in Chinese herbal medicine prevent and treat infections, and menthol to clear the heat. It treats insect bites and hot, red rashes and hives. My patients love it for these uses. The blood moving herbs explains it's ability to prevent scarring.

I also keep calendula ointment in my herbal first aid kit. i settled on using the burn ointment as the scratches were red (indicating heat, and possible infection) and to prevent scarring, my main concern on my face. In absence of Ching Wan Hung or infection, i would suggest using calendula ointment, rather than Vaseline. It should not cause any skin irritation, rather it treats that. it is readily available in the natural food stores. Check the ingredients to be sure its a clean ointment. I would avoid Boirion as it uses petroleum ointment.

The following morning i began researching the next step, scar prevention. Several colleagues suggested Resinall-K, a Health Concerns herbal tincture to improve wound healing and prevent scarring. Chris Macie gave a convincing testimonial:

It's an incarnation of a somewhat common hit-medicine for martial injuries; though some forms may be considered proprietary / esoteric. Contains Dragon's Blood, RuXiang (frankincense) & MoYao (Myrrh), YanHuSuo, etc., in suspension with alcohol and glycerin.

[It also contains san qi, the chief blood mover in yu nan bai yao, er cha, safflower and bing pian (borneol) resin.]

When used to continuously coat, even in a sense of immerse, a surface wound, it appears to promote near-seamless epithelial healing. (similar principle as touted in new Western bandage technology recently)

I keep a lot of it in stock; routinely prescribe to patients who have cats.

Couple of years ago I closed a car door completely on distal phalanx of my index finger -- cut to the bone (palmar side). Kept it packed in Res-K for a month or so. Took a total of about 6-months, but now 100% restored flesh & function; very faint scar.

Health Concerns lists the therapeutic actions of Resinall-K as preventing infections, promoting tissue regeneration, stopping bleeding and activating blood circulation. Therapeutic applications include pain and swelling of traumatic injury. When you look at the number of heavy-hitting blood moving herbs in the formula, it makes sense that it will prevent scarring by keeping the area moist, and keeping the blood moving. the alcohol base of the tincture enhances blood circulation. This is why hit liniments for martial arts are alcohol based.

I found a bottle of propolis in my first aid kit which treats infections. The scratches were a bright red at this point, indicating heat and toxins. so i applied the burn ointment and the propolis and bandaged up the scratches.

At the end of the day i picked up the Resinall-K. the propolis seem to clear any infectious process, as red coloration to the scratches had markedly diminished and there was no yellow exodus. I cleaned and reapplied the burn ointment and the Rensinall-K and re-bandaged. Every few hours i opened the dressing and reapplied the burn ointment and Resinall-K.

By the next morning, the redness had cleared, and the scratches were healing nicely. They look rather shallow, so i am less concerned, but still do not wish to have scars around my eye and on my cheek. once the scratches close up and it no longer seems necessary to bandage to keep them moist, i will move on to phase two: scar prevention.

Several colleagues suggested essential oils to prevent scarring. i looked at a couple of formulas, and came up with my own combination, partly based on cost, as purchasing a number of essential oils can add up.

Tamanu oil treats scars and infections, due to its antibiotic, anti-inflammatory properties, so its a keen choice to use as a carrier oil. other options suggested included castor oil, sesame, sweet almond oil, olive and grapeseed (for phytoestrogens) oils. I will probably used a castor/sesame oil combination, as i have these on hand. In my Flying Dragon Liniment for muscle and joint pain, i use organic castor, sesame, peach seed and olive oils.

Mary Elizabeth Wakefield, who has been teaching facial rejuvenation acupuncture for over a decade suggests this essential oil blend to treat keloid scars:

In a 4 oz blue bottle, put 3-4 drops each of: lavender oil, helichrysm oil and rose oil. Fill the rest of the way with a carrier oil (choose from apricot seed oil, grape seed oil or emu oil- which is known for treating scars on its own) Apply twice daily.

as a vegan i cannot recommend emu oil, as it is harvested from these Australian birds, but i did google it and it does have many healing properties.

Helichrysm was suggested by many of my colleagues, so i knew i wanted to use it. One practitioner suggested a blend of bay laurel, clary sage and helichrysum. When i began ordering i noticed the clary sage is about 25% higher in cost than the other oils, so i ordered lavender for its reputation to treat scars and infections, rose for its attributes for the skin, helichrysum as many practitioners suggested it for scarring and bay laurel. as the Snow Lotus helichrysum and rose i ordered are a 10% solution, they must be dosed 10x the # of drops one would normally use.

After 72 hours, the cuts were looking less red and were beginning to close. At this point i felt comfortable going out in public with out the bandage, just applying the burn ointment to keep the area moist, keep the blood circulating and prevent scabbing, which could cause scarring. while at home and overnight i kept the area bandaged up with the burn ointment and Resinall-K which was quickening the healing process. At 96 hours the superficial scratches were beginning to fade, and a couple of small scratches had already disappeared.

By 120 hours the wounds had closed and the scratches were beginning to fade. Therefore (and thankfully, i would add) the bandage was now unnecessary. It is still important to keep the blood circulating to prevent the blood stagnation which causes scarring. The Resinall-K is a dark red and rather messy. in addition to the menthol, the burn ointment has many blood moving herbs. so for practical considerations, i used the Resinall-K at home and the burn ointment in public.

By day 7 the scratches were now a pink coloration. One of the more prominent scratches had markedly faded, 50%. The Resinall-K seemed no longer necessary, so i began the essential oils. I began with the helichrysum neat, as it is in a 10% solution. It has a lite, pleasant citrus-y aroma. After 2 days with the helichrysum, two of the 3 prominent scratches had reduced to 15% visibility. There is now one long and prominent scratch which has faded to a pale pink coloration. I am now considering mixing up the remaining essential oils i ordered - rose, lavender and bay laurel - to help move along the healing of the more visible scratch.

As the sores begin to heal, acupuncturists needle the healing cuts to prevent scarring. Scar therapy also treats older scars. The general technique is to do something we call 'surround the dragon' where we needle the perimeter of the wound or scar. some practitioners needle perpendicular and under the scar tissue to break up the collagen formation, others needle parallel to the scar. Moxa is used to speed the healing. Many practitioners i talked to recommended laser therapy.

Bill Morse describes his experience:

. . .also use non-scarring moxa to excite the tissues and promote regeneration. With the local needles

The scar will often change character as the first sign of therapy. This may be variable. Hard scars become soft and sometimes hard for a bit then soften. Small scars will enlarge, soften and then reduce. There are many patterns. I like to think that there is "retracing" going on - that is, a reversal of the scars history. Many times patients will begin to recall the incident sequence which verifies this theory. Often there is no apparent connection.

Expect results or changes quickly, however thinning to a line may take several months, especially at thin skin areas like the face. Keloid scars are the most difficult to work with and require extensive internally applied herbs and may contra- indicate the use of moxa. Any scar wider that 1/8 inch will require special care and additional time.

I have seen 4 inch bed sores reabsorb completely with needle application only in a matter of days to weeks, but most deep scars require more time.

Denise Moran adds:

scars tend to start to get a little thicker at 3 months so don't be alarmed if that happens. By a year they have come close to healing, but you could still see some improvement. Keep using your oils and needling and any thickening should be at a minimum or non-existent. I treated my dad for 5 days after he had his kidney removed and at 5 months, it was hard to find the scar. So I'd probably start doing face points within about 72-96 (to avoid stirring up bleeding) hours of the injury, but not in the wound.

KB