Contact Sensitivity in Patients With Leg Ulcerations

Saap, Liliana; Fahim, Simone; Arsenault, Emily; Pratt, Melanie D.; Pierscianowski, T. A.; Falanga, Vincent; Pedvis-Leftick, Anita

doi:10.1001/archderm.140.10.1241

Cited by 89 publications

(11 citation statements)

References 21 publications

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“…Due to the high incidence of allergic reactions, the use of nitrofurazone in Western countries has been largely abandoned [7]. Nitrofurazone or PEG allergy has not been reported in recent studies investigating contact sensitivity to vehicle components in patients with chronic leg ulcer or stasis dermatitis in the United States or Europe [15–17]. Therefore, PEG 400 was removed from the North American Contact Dermatitis Group (NACDG) patch test series [15].…”

Section: Discussionmentioning

confidence: 99%

“…Nitrofurazone or PEG allergy has not been reported in recent studies investigating contact sensitivity to vehicle components in patients with chronic leg ulcer or stasis dermatitis in the United States or Europe [15–17]. Therefore, PEG 400 was removed from the North American Contact Dermatitis Group (NACDG) patch test series [15]. However, nitrofurazone is found in 1% petrolatum in India patch test series [18, 19].…”

Section: Discussionmentioning

confidence: 99%

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Cutaneous reactions caused by nitrofurazone

Bilgili

Ozaydin-Yavuz

Yavuz

et al. 2019

pdia

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IntroductionAllergic contact dermatitis (ACD) is a form of dermatitis due to type 4 hypersensitivity reaction that occurs when the skin comes into contacts with the topical product. Topical nitrofurazone is a widely used antimicrobial drug in our country which is well known to cause ACD.AimIn this study, ACD cases with different clinical features attributed to the use of nitrofurazone were evaluated.Material and methodsPatients hospitalized in our clinic between 2013 and 2017 with ACD diagnosis due to nitrofurazone were evaluated. The patient age, gender, atopy histories, clinical features, dissemination of the lesions, treatment given were reviewed.ResultsIn a 5-year period, 58 cases were identified and their data were analysed. Twelve patients were female (21%), 46 patients were male (79%). Clinical presentations were dyshidrosiform (45%), excoriated papules and plaques (33%), combined (21%), and erythroderma in one patient. The dissemination was generalized in 34 patients, localized in 14 patients, and local spread in 10 patients. The mean hospitalization time was 7 ±3 days, and ranged from 3 to 18 days.ConclusionsThere may be widespread and severe ACD due to the use of nitrofurazone. Topical nitrofurazone should not be applied on damaged skin as sensitization may develop. Patients and physicians should be aware of the ACD risk associated with topical nitrofurazone, which is also commonly used as self-medication, physicians should take a detailed history of the drug use and products containing nitrofurazone should not be used in conditions where skin integrity is not intact, whenever possible.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cutaneous reactions caused by nitrofurazone

Bilgili

Ozaydin-Yavuz

Yavuz

et al. 2019

pdia

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“…As discussed in section 7, topical therapy for stasis dermatitis and lower extremity ulcerations dramatically influences the spectrum of allergens found in older populations. [20,43,44] Uter et al [20] stratified patients into three age groups, £60, 61-75, and ‡76 years, and found that dermatitis of the legs was most prevalent in the oldest group and that ''the number of allergies (against a fixed set of allergens) actually increases almost linearly with the duration of the (lower extremity) ulcer.'' Thus, they concluded that allergic contact sensitivity is a function of not only age but agerelated co-morbidity.…”

Section: Medical Co-morbidities In Older Adultsmentioning

confidence: 99%

Contact Dermatitis in Older Adults

Prakash

Davis

2010

American Journal of Clinical Dermatology

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Contact dermatitis is a significant health problem affecting the elderly. Impaired epidermal barrier function and delayed cutaneous recovery after insult enhances susceptibility to both irritants and allergens. Exposure to more numerous potential sensitizers and for greater durations influences the rate of allergic contact dermatitis in this population. Medical co-morbidities, including stasis dermatitis and venous ulcerations, further exacerbate this clinical picture. However, while these factors tend to increase the degree of sensitization in the elderly, waning immunity can actually decrease such a propensity. This interplay of both intrinsic and extrinsic factors makes a generalization on trends for contact dermatitis in older adults challenging. The literature has varying reports on the overall incidence of allergic contact dermatitis with advancing age. Nevertheless, it does clearly show that sensitivity to topical medicaments increases with age. Irritant contact dermatitis studies are more consistent, with less reactivity (to irritants) in older compared with younger skin. Diagnosis of both irritant and allergic contact dermatitis is based on a thorough history, complete skin examination, and comprehensive patch testing. The mainstay of therapy is avoidance of the offending chemical substances and the use of topical along with systemic therapies, depending on the severity of the condition.

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“…-8 1+ 2+ 3+ 4+ 48 h Cosmetic grade, 100% 50 30 0 0 0 0 USP, 100% 47 33 0 0 0 0 Cosmetic grade, 70% 70 10 0 0 0 0 USP, 70% 68 12 0 0 0 0 96 h Cosmetic grade, 100% 75 5 0 0 0 0 USP, 100% 70 10 0 0 0 0 Cosmetic grade, 70% 78 2 0 0 0 0 USP, 70% 78 2 0 0 0 0 It has been described as responsible for contact allergic reactions due to the ingestion of foods containing the substance [19] and generalized reactions due to the intravenous administration of valium to 1 patient sensitive to PG [20] . However, the studies are sometimes contradictory, and the North American Contact Dermatitis Group found, in a 7-year study, 14% of sensitization in patients suffering from leg ulcers [21] . In our country, the sensitization is lower than in their study, but in order to have an idea of the real sensitization capacity of PG it has to be patch-tested at the appropriate concentration.…”

Section: Discussionmentioning

confidence: 99%

Propylene Glycol Today

Vilaplana¹,

Alsina²,

Coll³

et al. 2004

Exog Dermatol

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Propylene glycol (PG) has been described as responsible for contact allergy and irritant reactions, but there are a lot of non-conclusive studies reporting a different percentage of patients irritated, with diverse concentrations and doses applied. As this substance is contained in a large amount of products, we reviewed its irritant capacity and the appropriate concentration to be tested. PG from two different origins was tested in 230 healthy volunteers. We applied 25 µl of PG at two different concentrations (70 and 100%). PG from origin B (PGB) was tested furthermore with two different qualities. Biophysical measurements were performed in those subjects patch-tested with PGB and its acute dermal irritation was tested in human skin culture. After 48 h results did not show any difference between PG from both origins and qualities. After 96 h PGB was slightly more irritant than PGA. Biophysical measurements only increased significantly in the subjects with a positive allergic reaction and there were no differences in the in vitro test. PG is not valid as pattern of irritation even at 100% concentration because it irritates a small percentage of patients. The recommended concentration should be between 30 and 70% in water, and the 100% concentration could be used in non-reactive patients.

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Contact Sensitivity in Patients With Leg Ulcerations

Cited by 89 publications

References 21 publications

Cutaneous reactions caused by nitrofurazone

Cutaneous reactions caused by nitrofurazone

Contact Dermatitis in Older Adults

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