Peristomal allergic contact dermatitis – case report and review of the literature

Abstract

Allergic contact dermatitis (ACD) is a rare cause of peristomal skin problems. Only 23 cases have previously been reported in the literature. We report the case of a colostomy patient with a severe disabling blistering peristomal dermatitis. Patch testing to a British Contact Dermatitis Society standard series, medicaments and a plastics and glues series was negative. Patch testing to the patient's own products gave a positive reaction (+) at D2 and D4 to Dansac soft paste and Stomahesive paste. Further patch testing to the components of Dansac soft paste showed a positive (+) reaction at D2 and D4 to ester of polymethyl vinyl/maleic acid copolymer (Gantrez-ES) only. This is the first reported case of ACD due to Dansac soft paste. ACD to Gantrez has previously been reported but in different products. We also review the other previously reported cases of ACD causing peristomal dermatitis and stress the importance of patch testing in these cases, in particular to the patient's own products, as avoidance of identified allergens can have a large impact on the quality of life.

Peristomal skin complications: what dermatologists need to know

“…Critical patch testing is the gold standard diagnostic test to identify the allergen. In patch testing, we can use a standard tray for allergens that includes plastic, glues, cosmetics, and fragrance (Table ); however, in certain cases, we should consider testing for specific allergens, for example the patient's stoma bag itself, strapping, adhesive, adhesive removal, and other topical agents . A use‐testing method can also be used to identify the allergen in which patients will apply a pouching system and all other materials used on the normal side of the abdomen.…”

Thermal-history-dependent Phase Behavior of Ceramide Molecular Assembly in a UV-curable Acrylic Adhesive Resin

“…These adhesive materials are in direct contact with the skin. Although these occurrences are rare, some medical adhesive materials cause allergic contact dermatitis 3,4 . In addition, the following problem has emerged: physical stimulation by frequent application and removal of stoma appliances can damage skin.…”

Stoma care products represent a common and previously underreported source of peristomal contact dermatitis

“…It would be interesting to test as much as possible with the specific causative agents in appropriate concentrations and vehicles, respectively, to distinguish between allergy and irritancy. The published literature suggests that the most common allergens causing ACD in ostomates are epoxy resins (no longer used), Gantrez ® copolymers (ChemPoint, Bellevue, WA, USA), D-limonene, and (un)known allergens in various stoma skin care products (ostomy pouching systems, skin barriers, and adhesive removers) (8,9,(23)(24)(25)(26)(27)(28). Gantrez ® is a polymethylvinyl ether maleic anhydride copolymer (two formulations: Gantrez ® -425 and Gantrez ® -335) that is used in various personal care products, and as an adhesive component in a range of stoma pastes.…”