Indian Journal of Dermatology
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Year : 2014  |  Volume : 59  |  Issue : 4  |  Page : 424
Iatrogenic patterned scar secondary to branding

1 Department of Skin and STD, Mandya Institute of Medical Sciences, Mandya, Karnataka, India
2 Department of DVL, PESIMSR, Kuppam, Andhra Pradesh, India

Date of Web Publication27-Jun-2014

Correspondence Address:
B M Shashi Kumar
Department of Skin and STD, Mandya Institute of Medical Sciences, Mandya, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5154.135549

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How to cite this article:
Shashi Kumar B M, Reddy RR, Harish M M, Hanumanthayya K. Iatrogenic patterned scar secondary to branding. Indian J Dermatol 2014;59:424

How to cite this URL:
Shashi Kumar B M, Reddy RR, Harish M M, Hanumanthayya K. Iatrogenic patterned scar secondary to branding. Indian J Dermatol [serial online] 2014 [cited 2022 Jul 2];59:424. Available from:


Branding refers to a traditional practice of creating burns on the skin with a hot iron rod or metallic object. [1] The technique causes wounding, which heals with secondary intention, leaving permanent scars. In most cases, the aim is to produce a permanent patterned scar. [1] But, this is done without the basic understanding of healing or anticipating the possibility of formation of hypertrophic and keloidal scars. The patient may develop such scars, especially if the branding is done after puberty. [2] The possibility of hypertrophic and keloidal scars increases significantly since the wound gets infected and takes longer to heal without proper wound care as done in the quackery practices. In several Asian and African societies, where traditional medicine is still widely prevalent, branding is used as "counter irritation". This involves brief use of moderately intense pain to relieve chronic pain. [3] Many local and systemic complications are described following traditional branding. We report a case of patterned keloidal scar secondary to banding done for osteoarthritis of knee.

A 45-years-old female came with a complaint of raised scars over both the knees. On careful history-taking, she revealed it as consequent to branding. Patient had bilateral knee joint pain since two years. She had tried several treatment options in allopathy, Ayurveda, and homeopathy. She consulted a traditional healer a month back, who did branding on the anterior aspect of both the knees with hot bangles. Patient had pain and ulcer over the branding site, which healed over a period of 4 weeks, leaving behind the present lesions. It was associated with mild and occasional itching. No personal or family history suggestive of keloidal tendency, hypertension, or diabetes was elicited.

On examination, the patient had multiple raised, non-tender keloidal scars arranged in regular rows over the anterior aspects of both the knees [Figure 1] and [Figure 2]. X-ray of knee joint showed features of osteoarthritis. Routine blood and urine examination were within normal limits. Intralesional triamcinolone acetonide was given to each of the larger lesions, which reduced the size of the lesions with residual scars.
Figure 1: Patterned scar over both knees

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Figure 2: Close - up view showing raised scar arranged in rows

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Human branding is the process, in which a mark is made on the skin of a living person by burning, resulting in permanent scarification. In rural India, branding is practiced as a method of prevention or treatment of many diseases. The family members usually believe that the offending agent comes out of the branding site ridding the body of the disease. [4] Many medical conditions such as post-herpetic neuralgia, backache, sciatica, arthritis, paralysis, facial palsy, ascites, splenomegaly, lymphadenopathy, jaundice, glaucoma, migraine headaches, and sore throat are the main area of target by traditional healers. [5] Branding procedures can cause disfigurement from contractures (especially over joint surfaces), scars, hair loss, keloids, orthokeratotic hyperkeratosis, acanthosis, and squamous cell carcinoma (Marjolins ulcer). Other medical complications include foreign body reaction, oral and tooth complications, aspiration and hypoxia, edema and swelling, infections and viral transmission including hepatitis and HIV. [6],[7],[8],[9] Raza et al. in their case reports have described many life-threatening complication like septic shock, cavernous sinus thrombosis, and multiple splenic abscesses secondary to branding. [3] We think it is appropriate to report a case of patterned keloidal scar secondary to banding done for osteoarthritis of knee.

   References Top

1.Karamanoukian R, Ukatu C, Lee E, Hyman J, Sundine M, Kobayashi M, et al. Aesthetic skin branding: A novel form of body art with adverse clinical sequela. J Burn Care Res 2006;27:108-10.  Back to cited text no. 1
2.Mataix J, Silvestre JF. Cutaneous adverse reactions to tattoos and piercings. Actas Dermosifiliogr 2009;100:643-56.  Back to cited text no. 2
3.Raza S, Mahmood K, Hakeem A, Polsky S, Haemel A, Rai S. Adverse clinical sequelae after skin branding: A case series. J Med Case Rep 2009;3:25.  Back to cited text no. 3
4.Taneja DK, Singhal PK, Dharana S. Superstitions in pediatric illness among rural mothers. Indian Pediatr 1988;25:447-52.  Back to cited text no. 4
5.Wand-Tetley JI. Historical methods of counter-irritation. Ann Phys Med 1956;3:90-9.  Back to cited text no. 5
6.Kaatz M, Elsner P, Bauer A. Body-modifying concepts and dermatologic problems: Tattooing and piercing. Clin Dermatol 2008;26:35-44.  Back to cited text no. 6
7.Tweeten SS, Rickman LS. Infectious complications of body piercing. Clin Infect Dis 1999;26:735-40.  Back to cited text no. 7
8.Pugatch D, Mileno M, Rich JD. Possible transmission of human immuno-deficiency virus type 1 from body piercing. Clin Infect Dis 1998;26:767-8.  Back to cited text no. 8
9.Hayes M, Harkness G. Body piercing as a risk factor for viral hepatitis: An integrative research review. Am J Infect Control 2001;29:271-4.  Back to cited text no. 9


  [Figure 1], [Figure 2]


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