A Case of Skin Ulcer in Severe Acute Malnutrition Treated with Hyperoil<sup>®</sup>

Case Report

Austin J Clin Case Rep. 2017; 4(1): 1111.

A Case of Skin Ulcer in Severe Acute Malnutrition Treated with Hyperoil®

Iabichella ML¹*, Fusari V², Largo P¹, Pediliggieri C¹, Sawadogo E³, Izzo A4, Bertolotti A4 and Bonanomi G5

¹Helios Med Onlus, International Health Cooperation, Italy

²Department of Political and Social Sciences, University of Pavia, Italy

³Filles de Saint Camille, Nutritional Recovery Centre, Benin

4Inter Med Onlus, International Health Cooperation, Italy

5Departmrnt of Surgery, Chelsea and Westminster Hospital, UK

*Corresponding author: Maria Letizia Iabichella, Helios Med Onlus, International Health Cooperation, 97016 Pozzallo (RG), Italy

Received: October 19, 2016; Accepted: January 27, 2017; Published: January 31, 2017


A 3 years old baby with complicated SAM and extended exudating, smelling, advanced and infected lesions on both lower legs has been treated with Hyperoil Mgel gauzes at NRC. Surprisingly, in few days her trophic lesions recovered avoiding keloids and cutaneous discoloration.

Keywords: Severe acute malnutrition; Edema; Kwashiorkor; Skin ulcer; Child; Hyperoil®


Malnutrition is complex condition which has social repercussions and is associated with medical disorders [1].

In Sub-Saharan Africa, malnutrition is a relevant emergency, directly or indirectly responsible for 35% of child mortality [2].

According to the World Health Organization (WHO) standards, SAM in 6-60 months old infants and children is defined by a very low weight for height (below -3z scores of the median WHO growth standards), by visible severe wasting (Mid-Upper Arm Circumference (MUAC) less than 115 mm), or by the presence of nutritional edema (clinical sign). These standards are appropriate for infants and children of different ethnic groups.

SAM is characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. Sufficient calorie intake, but with insufficient protein consumption, distinguishes it from Moderate Acute Malnutrition (MAM, below -2z scores of the median WHO growth standards). MAM rapidly improves, whereas children affected by SAM are apathetic, with swollen abdomen, and have a poorly responsive immune system [1].

Generally, SAM can be treated by adding protein to the diet; however, it can have a long-term impact on a children’s physical and mental development and they can fall victim to untreatable infections and that, in severe cases, might lead to mortality. In fact, two types of Protein-Energy Malnutrition (PEM) have been described: kwashiorkor and marasmus. Kwashiorkor occurs with fair or adequate calorie intake but inadequate protein intake, whereas marasmus occurs when the diet is inadequate in both calorie and protein intakes [3].

Children having SAM or MAM, defined according with WHO standards, are followed and treated at the Nutritional Recovery Centre (NRC) run by the P.M.I. “Filles de St. Camille” in Zinviè (Benin) and supported by Helios Med and InterMed in educating and treating malnutrition, in order to reduce its their impact on child mortality.

The staff of Helios Med and InterMed, two Italian non-profit international health organizations, uses to go periodically to Zinviè where they built up a wound care centre and in their short missions train local health care providers working there. Training includes the preparation of ozonated water by bubbling O2-O3 in a 2,000 ml glass bottle for five minutes at the concentration of 30 μg/ml to clean ulcer bed and perilesional area; antiseptic treatment of the wounds with ozone therapy, being the standard protocol applied for the treatment of Buruli Ulcer [4]. Since 2013 they introduced an alternative wound local treatment, already used in 2012 in the Democratic Republic of Congo to treat the Buruli Ulcer [5,6], named Hyperoil®, a hypericum flowers (Hypericum perforatum) extract in neem oil (Azadirachta indica) produced by RIMOS srl Mirandola (MO) – Italy: it was the only available antiseptic. It was available in oily, gel and medicated gauzes formulation (Medical Device Class IIB CE0476), and it has already been used in complicated diabetic foot ulcers [7].

Case Presentation

18 months old female with complicated SAM (WHO Z-score < -3), attended the NRC. The local assistant (Sister Emilienne) rated her overall clinical status as a very critical, with high death risk because of extended, exudating, smelling, advanced (2 months) edema and infected lesions on both lower legs.

To contrast F’s severe conditions, the standard hyperproteic feeding treatment (multivitamin, nistatine, amoxicilline) as promoted by the WHO guidelines [8] was immediately started leading to the clinical recovery of F in 4 weeks.

Lower legs lesions were cleaned with ozonated water [9,10] by Sister Emilienne and treated with Hyperoil® medicated gauzes, kindly donated by Helios Med Onlus.

Sister Emilienne observed an unexpected improvement of lesions (Figure 1) 2 days after the first dressing. More in detail, she reported reduced fibrin (Figure 2A), edema, inflammation and exudate secretion, perilesional skin recovery (Figure 2B), smell disappearance and cleaned wound bed.

Citation: Iabichella ML, Fusari V, Largo P, Pediliggieri C, Sawadogo E, Izzo A, et al. A Case of Skin Ulcer in Severe Acute Malnutrition Treated with Hyperoil®. Austin J Clin Case Rep. 2017; 4(1): 1111. ISSN:2381-912X