High incidence of contact dermatitis in leg-ulcer patients-implications for management

Abstract

A retrospective review of patch test results from all new patients with venous leg ulcers was performed for the preceding 11 months. Eighty one patients referred from general practitioners and district nurses with venous stasis ulcers were included. Positive patch tests were found in 54 patients (67%), including a continued high incidence of allergy to lanolin and topical antibiotics. Multiple allergies were found in 48 patients (58%). In addition, a new problem of allergy to cetearyl alcohol, a constituent of commonly used creams and paste bandages, was identified in 13 patients. There is a continuing high incidence of contact sensitivity in patients with venous stasis ulcers which has important implications for the management of these patients.

Contact Sensitivity in Patients With Leg Ulcerations

“…Some of the European studies showed similar high frequencies of sensitization to the following allergens compared with our study: balsam of Peru, 3,[7][8][9]11 fragrance mix, 4,7,9,11 benzalkonium chloride, 9,11 nickel, 4,6,8 and hydrogel with propylene glycol. 8 Allergen sensitivities to neomycin [2][3][4][5][6][8][9][10][11] and lanolin 3-11 were higher in the European studies.…”

“…Some of the European studies showed similar high frequencies of sensitization to the following allergens compared with our study: balsam of Peru, 3,[7][8][9]11 fragrance mix, 4,7,9,11 benzalkonium chloride, 9,11 nickel, 4,6,8 and hydrogel with propylene glycol. 8 Allergen sensitivities to neomycin [2][3][4][5][6][8][9][10][11] and lanolin 3-11 were higher in the European studies. However, sensitivities to the following allergens were lower in the European studies compared with our study: bacitracin, 3 wood tar mix, [2][3][4][5]8,10 propylene glycol, 3,5,7-10 carba mix, 4-6 formaldehyde, [2][3][4][6][7][8][9][10] quaternium-15, 4-6,9,10 Euxyl K400.…”

“…8 Allergen sensitivities to neomycin [2][3][4][5][6][8][9][10][11] and lanolin 3-11 were higher in the European studies. However, sensitivities to the following allergens were lower in the European studies compared with our study: bacitracin, 3 wood tar mix, [2][3][4][5]8,10 propylene glycol, 3,5,7-10 carba mix, 4-6 formaldehyde, [2][3][4][6][7][8][9][10] quaternium-15, 4-6,9,10 Euxyl K400. 8 Control gel hydrocolloid and 2-bromo-2-nitropropane-1,3-diol (bronopol) were not tested in any of the European studies.…”

A Systematic Review and Meta-analysis of Exercise Intervention for the Treatment of Calf Muscle Pump Impairment in Individuals with Chronic Venous Insufficiency

“…32 Two studies in which patients with venous leg ulcer were patch-tested for a range of allergens contained in current ulcer dressings (as additions to the European standard series), found that in one, 46% and in the other, 61% of reactions were to these additional allergens. 33,34 Several large patch-test studies have demonstrated that the principal sensitisers are ingredients of applications, dressings, and bandages, with common sensitisers being lanolin, antibiotics, antiseptics, preservatives, emulsifers, resins and latex. [32][33][34][35][36][37] D Leg ulcer patients with dermatitis/eczema should be considered for patch-testing using a leg ulcer series.…”

“…33,34 Several large patch-test studies have demonstrated that the principal sensitisers are ingredients of applications, dressings, and bandages, with common sensitisers being lanolin, antibiotics, antiseptics, preservatives, emulsifers, resins and latex. [32][33][34][35][36][37] D Leg ulcer patients with dermatitis/eczema should be considered for patch-testing using a leg ulcer series. Detailed indications and procedures for referral should be discussed at a local level for inclusion in local guidelines.…”