title: A very interesting traditional method in the treatment of skin lesions: aqua regia and related complications.
abstract: BACKGROUND
  Aqua regia, a highly corrosive mixture of concentrated nitric acid and hydrochloric acid, is used to dissolve various metals such as gold and platinum that are not soluble in other types of acids. For the first time in the literature, we report the adverse effects that were observed following the utilization of this strong acid solution in the treatment of various skin lesions.
  
  
  METHODS
  Between 2010 and 2013, 43 patients (55.8 % female) with a mean age of 40.2 years, were admitted to our hospital for scars, wounds or malign lesions related to the use of aqua regia on skin lesions. Sixteen patients reported to use aqua regia for treating wounds and 27 of them used it for their scars.
  
  
  RESULTS
  Out of 43 patients, 9 patients developed necrosis, 12 had hypertrophic scars, 15 had scars and 7 had non-healing wounds resembling malignant lesions. The non-healing wounds were located in the facial region in five patients, in the cervical region in one and on the finger-tip in another. Histopathological examination of these non-healing wounds revealed basal and squamous cell carcinoma. The patients were admitted to the plastic surgery department approximately 6-24 months after aqua regia application with complaints of growing lesions. Secondary healing in the lesions with scar development in 55 % of the patients is an acceptable result. However, 27 % of the patients with hypertrophic scars and 16 % of the patients with malignant lesions required intervention.
  
  
  CONCLUSIONS
  This present study showed that non-medical alternative treatments have major risks. Aqua regia application might have resulted in the development or rapid progression of malignant tumours in seven patients. In the literature, it has been reported that a number of physical traumas may cause skin cancer. Based on this information, the possibility of such an effect of aqua regia cannot be excluded.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Adıyaman University, Altınşehir Mh. 3005 Sokak No:13, 02040 Adıyaman, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Doğan
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Erciyes University, Kayseri, Turkey.
authors.forename: Cemal Alper
authors.initials: CA
authors.lastname: Kemaloğlu
keywords: Aqua regia; Chemical burns; Non-medical treatments