Contact Allergic Investigations in 100 Patients with Ulcus Cruris

Abstract

The incidence of contact-allergic reactions to some 10 substances out of 75 tested in 100 selected leg-ulcer patients is about 5 times as high as in eczematous patients. These substances are p-phenylenediamine, p-aminoazobenzene, Pellidol®, benzocaine, diaminodiphenylmethane, neomycin, coal tar, balsam of Peru, wool alcohols. Sesame oil was the tenth substance. It is used to clean the skin from rests of ointments. In Holland it figures as a constituent of the often-used, so-called pasta zinci oleosa, ung. diachylon, ung. simplex, and of emulgide cream. In our opinion, not only topical medicaments should be regarded as frequent contact sensitizers in leg-ulcer patients. A second class of important sensitizers in this group of patients appears to be the para-substituted substances such as p-phenylenediamine (and azo dyes) as inducers considered to be responsible for the cross-reaction of drugs such as benzocaine and sulfanilamide, and of the rubber additive, diaminodiphenylmethane. Stress is laid upon five preventive measures concerning contactants in leg-ulcer patients (stockings, bandages, topical medications) and upon the desirability of having non-sensitizing preservatives and stabilizers at one’s disposal–especially for topical medications in leg-ulcer patients who apparently are sensitized with greater ease than patients with other skin ailments.

A Retrospective Study of Patch Test Results from 163 Patients with Stasis Dermatitis or Leg Ulcers

“…below) and potassium dichromate is a mild irritant [12], Furthermore, contact sensitivity to chromates is quite common among Belgian housewives because of the popular use of Javel®, a cleansing product that contains chromates [H. Degree/, Symposium on Contact Dermatitis, Copenhagen, 1977], Sensitization indices higher than 2 occurred for irritants such as wood tars and coal tar [14] and for topical agents. According to the literature [1-5, 7,10,11,14,16,17], wool alcohols, balsam of Peru, benzocaine (sulphanil amide), oxyquinolines, parabens, and neomycin are the most common contact allergens among stasis dermatitis patients.…”

“…According to Malten [10], contact allergy in leg ulcer patients is related not only to the existence of a dermatitis surrounding the ulcer, but also to the degree of acuteness of the ulcer itself, the delay in the healing time of the ulcer, and/or the increase in complaints of pain in spite of improvement in the clinical aspects of the ulcer itself.…”

Chapter 6 - Oral medication

“…It was shown in various studies that in the case of contact allergies there was generally an allergy to components such as Peru balsam and lanoline in wound ointments, topical antibiotics, wound dressings and bandages whereby there was a clear relationship between the duration of the ulcers and the occurrence of contact allergies. [53][54][55][56][57][58][59][60][61] One should always consider the possibility of contact allergy when there are indications of slow wound healing. This often manifests in the form of eczema.…”

p‐Phenylenediamine [MAK Value Documentation, 1993]

“…Occlusive patch tests (1 % p-phenylenediamine in surgical spirit) carried out on 100 patients (79 women, 21 men) with Ulcus cruris produced positive skin reactions in 27 persons (sex not specified) [43]. The effect of hair dyed with p-phenylenediamine was tested in 20 persons (19 women, 1 man), all of whom gave strongly positive reactions to p-phenylenediamine in a patch test.…”