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Das A, Sil A, Kumar P, Neema S. Chronic venous insufficiency: Part 2 Diagnosis and treatment. Clin Exp Dermatol 2022; 47:1240-1255. [PMID: 35212409 DOI: 10.1111/ced.15152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
Chronic venous insufficiency (CVI) is a common medical condition that results from venous hypertension of the extremities, leading to significant morbidity. The diagnosis of CVI is quite straightforward from patient history and obvious clinical manifestations. In the recent past, availability of various invasive and non-invasive modalities have assisted in evaluation of such cases. Although compression therapy is the mainstay of management, newer surgical and other interventional techniques are now being considered for patients who do not respond to conventional medical management. This review article will outline a diagnostic approach in cases of CVI and discuss the management principles encompassing conservative, pharmacological, and interventional options.
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Affiliation(s)
- Anupam Das
- Department of Dermatology, Venereology, and Leprosy; KPC Medical College & Hospital, Kolkata, India Consultant Dermatologist, Katihar, Bihar, India
| | - Abheek Sil
- Department of Dermatology, Venereology, and Leprosy; RG Kar Medical College & Hospital, Kolkata, India
| | | | - Shekhar Neema
- Department of Dermatology, Venereology, and Leprosy; Armed Forces Medical College, Pune, India
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Prevalence and trend of allergen sensitization in patients with a diagnosis of stasis dermatitis referred for patch testing, North American contact dermatitis group data, 2001-2016. Arch Dermatol Res 2021; 314:857-867. [PMID: 34748058 DOI: 10.1007/s00403-021-02295-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/22/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Few studies explored the relationship between stasis dermatitis (SD) and allergic contact dermatitis (ACD). OBJECTIVE To examine trends, associations, and clinical relevance of ACD in patients referred for patch testing who had a final SD diagnosis. METHODS Retrospective analysis from 2001 to 2016 of 38,723 patients from the North American Contact Dermatitis Group. RESULTS After patch testing, 303 (0.7%) patients were diagnosed with SD; 46.7% had a concomitant diagnosis of ACD. Patients with vs. without a final SD diagnosis had similar proportions of ≥ 1 positive allergic reaction (59.7% vs. 64.7%; Chi-square, P = 0.0724) but higher odds of allergic reactions to fragrance mix I, bacitracin, quaternium-15, Myroxylon pereirae, benzalkonium chloride, ethyleneurea melamine formaldehyde, diazolidinyl urea, and propylene glycol. The most commonly relevant allergens in patients with final SD diagnosis were fragrance mix I, Myroxylon pereirae, bacitracin, quaternium-15, and formaldehyde. The most common allergen sources were personal care products, topical medications and other health aid products. CONCLUSION Nearly half of patients with a final SD diagnosis were also diagnosed with ACD, supporting the role of patch testing in select SD patients.
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Alavi A, Goldenberg A, Jacob S, Shelley A, Kirsner RS. Contact dermatitis: An important consideration in leg ulcers. Int J Womens Dermatol 2021; 7:298-303. [PMID: 34222587 PMCID: PMC8243149 DOI: 10.1016/j.ijwd.2020.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/06/2020] [Accepted: 12/17/2020] [Indexed: 11/15/2022] Open
Abstract
The prevalence of chronic wounds is increasing with the aging population, with 1% to 2% of the worldwide population experiencing leg ulcers and positive patch tests reported in up to 75% of this population. With the introduction of modern dressings and compression therapies, clinicians should be cognizant of the potential risk of contact dermatitis in patients with leg ulcers. Contact dermatitis (both allergic and irritant) to wound products may present as maceration, pain, and overall impaired wound healing. Herein, we review the literature on contact dermatitis to wound-care products.
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Affiliation(s)
- Afsaneh Alavi
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Alina Goldenberg
- Medical Group of North County, Scripps Affiliated Medical Group, Oceanside, CA, United States
| | - Sharon Jacob
- Department of Medicine and Pediatrics (Dermatology), University of California, Riverside, CA, United States
| | - Amanda Shelley
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Robert S Kirsner
- Department of Dermatology, University of Miami, Miami, FL, United States
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Garval E, Plee J, Lesage C, Grange-Prunier A, Bernard P, Perceau G. [Frequency of contact sensitization to modern dressings used to treat chronic leg ulcer]. Ann Dermatol Venereol 2018; 145:339-346. [PMID: 29673752 DOI: 10.1016/j.annder.2018.01.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 09/03/2017] [Accepted: 01/15/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Allergic contact dermatitis around chronic leg ulcers (CLU) is a common complication in patients presenting CLU and prolongs healing times. The aim of this study was to describe the rate of sensitization to modern dressings (MD) used in these patients and to assess whether there is a relation between the number of sensitizations and ulcer type, the time from onset of the ulcer, and patient age and gender. PATIENTS AND METHODS We conducted a retrospective study at Reims University Hospital between 2010 and 2014 that included all patients with CLU of vascular etiology surrounded by eczematous lesions, and who had one of the patch-tests in the following 3 series: European baseline±leg ulcers±corticosteroids. RESULTS Among the 73 patients included, 43 % were polysensitized. Thirty-three patients (45 %) were sensitized to MD (38 % to hydrocolloids, 18 % to hydrogels, 7 % to hydrocellular dressings, 7 % to hydrofiber dressings, 5 % to contact layers and 3 % to alginates). Median age and sex did not differ between "polysensitized" patients and "non-polysensitized" patients (P=0.84 and P=0.25, respectively). Polysensitization was more frequent among patients presenting ulcers for more than 5 years (P=0.032). CONCLUSION Practically half of all patients presenting CLU with surrounding contact dermatitis had sensitization to modern dressings (mostly hydrocolloids and hydrogels). The rate of sensitization increased with the length of presence of CLU.
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Affiliation(s)
- E Garval
- Service de dermatologie, CHU, avenue du Général-Koenig, 51100 Reims, France.
| | - J Plee
- Service de dermatologie, CHU, avenue du Général-Koenig, 51100 Reims, France
| | - C Lesage
- Service de dermatologie, CHU, avenue du Général-Koenig, 51100 Reims, France
| | - A Grange-Prunier
- Service de dermatologie, CHU, avenue du Général-Koenig, 51100 Reims, France
| | - P Bernard
- Service de dermatologie, CHU, avenue du Général-Koenig, 51100 Reims, France
| | - G Perceau
- Service de dermatologie, CHU, avenue du Général-Koenig, 51100 Reims, France
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Erfurt-Berge C, Geier J, Mahler V. The current spectrum of contact sensitization in patients with chronic leg ulcers or stasis dermatitis - new data from the Information Network of Departments of Dermatology (IVDK). Contact Dermatitis 2017; 77:151-158. [PMID: 28194803 DOI: 10.1111/cod.12763] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with lower leg dermatitis, chronic venous insufficiency or chronic leg ulcers have a high prevalence of contact sensitization. OBJECTIVES To identify the current spectrum of contact allergens in these patients. PATIENTS AND METHODS Data of the Information Network of Departments of Dermatology on 5264 patients with the above diagnoses from the years 2003 to 2014 (study group) were compared with data on 4881 corresponding patients from 1994 to 2003 (historical control group) and with a current control group without these diagnoses (n = 55 510). RESULTS Allergic contact dermatitis was diagnosed less frequently in the study group than in the historical control group (25.9% versus 16.9%; p < 0.001), and contact sensitization to most allergens had declined. The allergen spectrum, however, was largely unchanged. Important allergens are Myroxylon pereirae (balsam of Peru) (14.8% positive reactions), fragrance mix I (11.4%), lanolin alcohol (7.8%), colophonium (6.6%), neomycin sulfate (5.0%), cetearyl alcohol (4.4%), oil of turpentine (3.1%), and paraben mix (2.6%). Patch testing with additional series showed sensitization to Amerchol L-101 (9.7%), tert-butyl hydroquinone (8.7%), framycetin sulfate (5.0%), and gentamicin sulfate (3.1%). CONCLUSIONS Topical preparations for treating the above-mentioned conditions should not contain fragrances, Myroxylon pereirae, and colophonium. The special allergen spectrum has to be considered in patch testing.
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Affiliation(s)
| | - Johannes Geier
- Information Network of Departments of Dermatology (IVDK), University Medical Centre Göttingen, 37075, Göttingen, Germany
| | - Vera Mahler
- Department of Dermatology, University Hospital Erlangen, 91054, Erlangen, Germany
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Evidence-based (S3) guidelines for diagnostics and treatment of venous leg ulcers. J Eur Acad Dermatol Venereol 2016; 30:1843-1875. [PMID: 27558268 DOI: 10.1111/jdv.13848] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
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Chapter 2 - Diagnostics. J Eur Acad Dermatol Venereol 2016. [PMID: 27558780 DOI: 10.1111/jdv.3_13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Renner R, Wollina U. Contact Sensitization in Patients with Leg Ulcers and/or Leg Eczema: Comparison between Centers. INT J LOW EXTR WOUND 2016; 1:251-5. [PMID: 15871978 DOI: 10.1177/1534734602239654] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with leg ulcers and/or eczema of the legs are at risk of contact sensitization. The aim of this retrospective study was to investigate the impact of some aspects of practice of leg ulcer treatment and availability of drugs and dressings in a university-based wound care center. These data were compared with those from the Information Network of Departments of Dermatology (IVDK), where patch test reactions of 3529 patients with leg ulcers and/or eczema of the lower legs were documented. Data analyses showed frequencies of sensitization for single and multiple allergens. The change of treatment modalities may have a positive impact on lowering sensitization rates, but the ongoing use of topical drugs outside wound care centers may be expected to limit the effects of modern wound treatment.
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Affiliation(s)
- Regine Renner
- Department of Dermatology and Allergology, University of Jena, Germany
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Artüz F, Yılmaz E, Külcü Çakmak S, Polat Düzgün A. Contact sensitisation in patients with chronic leg ulcers. Int Wound J 2015; 13:1190-1192. [PMID: 25851334 DOI: 10.1111/iwj.12442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/05/2015] [Accepted: 02/20/2015] [Indexed: 11/29/2022] Open
Abstract
The aim of our study is to identify the allergens in patients with leg ulcers who have contact dermatitis surrounding the skin of the ulcer and compare them with a control group consisting of patients with lower extremity contact dermatitis. A total of 40 patients with chronic leg ulcers (CLU) and contact dermatitis around the skin of ulcer were included in the study. As a control group, 20 patients with contact dermatitis of lower extremity without leg ulcers were included. The patient and control groups were patch tested with 37 allergens of the European Standard Series. Of the 40 patients, 31 (77·5%) had positivity to one or more allergens, and 10 (50%) of the control group patients had positivity to one or more allergens. The number of patients who had positivity to at least one allergen was significantly higher in the patient group (P < 0·05). Positivity to the balsam of Peru and benzocaine was significantly higher in the patient group than that in the control group (P < 0·05). Contact sensitisation to benzocaine and balsam of Peru was found to be associated with the presence of CLU. The efficacy of therapy in patients with leg ulcers might be increased by avoiding these allergens.
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Affiliation(s)
- Ferda Artüz
- Dermatology Clinic, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Emrah Yılmaz
- Dermatology Clinic, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Seray Külcü Çakmak
- Dermatology Clinic, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Arife Polat Düzgün
- General Surgery Clinic, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Reich-Schupke S, Kurscheidt J, Appelhans C, Kreuter A, Altmeyer P, Stücker M. Epikutantestung bei Patienten mit Ulcus cruris unter besonderer Berücksichtigung moderner Wundprodukte. Hautarzt 2010; 61:593-7. [DOI: 10.1007/s00105-010-1972-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nečas M, Dastychová E. Contact sensitization in patients with lower extremity dermatitis in the South Moravian region, Czech Republic. Phlebology 2010; 25:132-7. [DOI: 10.1258/phleb.2009.009024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives The aim of the study was to determine the frequency of contact sensitization in patients with lower extremity dermatitis. Methods Between the years 2001 and 2007, the authors investigated 462 patients (mean age 49.1 years, 196 men and 266 women) with the eczema/dermatitis localized on their lower extremities, including feet. The patients were investigated with epicutaneous tests of the European Standard Series and also with other special patch tests. Results The most frequent allergens were balsam of Peru, 44/462 (9.5%); wool alcohols, 41/462 (8.9%); nickel sulphate, 39/462 (8.4%); propolis, 35/462 (7.6%); fragrance mix, 34 (7.4%) and colophony, 29/462 (6.3%). Conclusions In patients with lower extremity dermatitis the frequency of contact sensitization is still high, and therefore investigation with epicutaneous tests should belong to the routine dermatological diagnostic procedure in these patients.
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Affiliation(s)
- M Nečas
- Ist Department of Dermatovenereology, Masaryk’s University and St Anna Faculty Hospital, Brno, Czech Republic
| | - E Dastychová
- Ist Department of Dermatovenereology, Masaryk’s University and St Anna Faculty Hospital, Brno, Czech Republic
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Freise J, Kohaus S, Korber A, Hillen U, Kroger K, Grabbe S, Dissemond J. Contact sensitization in patients with chronic wounds: Results of a prospective investigation. J Eur Acad Dermatol Venereol 2008; 22:1203-7. [DOI: 10.1111/j.1468-3083.2008.02775.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jankićević J, Vesić S, Vukićević J, Gajić M, Adamič M, Pavlović MD. Contact sensitivity in patients with venous leg ulcers in Serbia: comparison with contact dermatitis patients and relationship to ulcer duration. Contact Dermatitis 2007; 58:32-6. [DOI: 10.1111/j.1600-0536.2007.01253.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barron GS, Jacob SE, Kirsner RS. Dermatologic Complications of Chronic Venous Disease: Medical Management and Beyond. Ann Vasc Surg 2007; 21:652-62. [PMID: 17823046 DOI: 10.1016/j.avsg.2007.07.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 04/09/2007] [Accepted: 07/13/2007] [Indexed: 11/19/2022]
Abstract
Patients with venous insufficiency commonly develop complications which can result in significant morbidity and occasional mortality. Venous leg ulcers, the most prevalent type of lower extremity ulcer, are the most frequent sequela of venous insufficiency and negatively affect quality of life for the patient. Most have focused on venous ulceration, but other complications may arise including dermatitis, atrophie blanche, lipodermatosclerosis, and malignancy. Contact dermatitis is a common complication seen in the treatment of venous disease. Patients with venous insufficiency have a disrupted epidermal barrier, making them more susceptible than the general population to contact sensitization and subsequent dermatitis. Venous dermatitis is often the first manifestation of venous insufficiency and needs to be addressed promptly. Atrophie blanche, an end point of a variety of conditions, appears as atrophic plaques of ivory white skin with telangiectasias. Lipodermatosclerosis is an indurated plaque in the medial malleolus which can, at times, be quite tender and painful. Malignant degeneration is a rare but important complication of venous disease since tumors which develop in the setting of an ulcer tend to be more aggressive. Pain is a feature of venous disease often overlooked and commonly undertreated. Finally, psychosocial issues such as anxiety and depression are more common in patients with venous disease and should be adequately addressed. Recognizing these complications of chronic venous insufficiency is important as early intervention is the key to preventing unnecessary patient suffering and discomfort.
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Green CM, Holden CR, Gawkrodger DJ. Contact allergy to topical medicaments becomes more common with advancing age: an age-stratified study. Contact Dermatitis 2007; 56:229-31. [PMID: 17343625 DOI: 10.1111/j.1600-0536.2006.01084.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Eczema is common in the elderly people who often use topical medicaments. Previous studies in the elderly people have noted allergic positive patch tests in between 43% and 64% of those tested. We set out to assess whether medicament contact allergies are more common in elderly patients. We undertook a retrospective age-stratified study of all patients patch tested at the Royal Hallamshire Hospital, Sheffield, between January 1994 and July 2005. We confirmed that contact allergy to topical medicaments is more common in those aged more than 70 years compared with the younger age groups. There was no sex difference. The commonest problematic allergen types found in medicaments were fragrances and preservatives. The most frequent individual allergens were fragrance mix, Myroxylon pereirae, lanolins, local anaesthetic agents, neomycin and gentamicin, and tixocortol pivolate. The pattern of medicament contact allergens was similar to that of the younger age groups except that multiple allergic positives were more frequent and sensitivities to local anaesthetics and Myroxylon pereirae were proportionally more common. Elderly patients were more likely to have multiple contact allergies than the younger ones. Care needs to be taken when prescribing topical medicaments to elderly patients with eczema, especially for preparations that contain perfumes, lanolins, and local anaesthetics.
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Affiliation(s)
- Carl M Green
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
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Hampton S. The nursing care of common raw and bleeding skin conditions. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2004; 13:618-20. [PMID: 15215720 DOI: 10.12968/bjon.2004.13.10.13054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The skin is the largest organ in the body, is vital to the maintenance and balance of the body and is an indispensable structure for human life. The maintenance of healthy skin depends on factors such as moisture, the nutritional status of the patient and mechanical forces. Clever use of barrier films, barrier creams, emollients, steroid cream and observation of the patient's tissues over time, will protect the skin from external stimulants.
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Tavadia S, Bianchi J, Dawe RS, McEvoy M, Wiggins E, Hamill E, Urcelay M, Strong AMM, Douglas WS. Allergic contact dermatitis in venous leg ulcer patients. Contact Dermatitis 2003; 48:261-5. [PMID: 12868967 DOI: 10.1034/j.1600-0536.2003.00111.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Our aim was to determine the frequency and nature of contact sensitivity in venous leg ulcer patients in Lanarkshire. We performed patch testing with the European standard series, antimicrobials and medicaments on 200 patients referred to our leg ulcer clinics. Positive patch tests were found in 136 (68%) patients. Multiple allergies occurred in 102 (51%). The most frequent allergen groups were fragrances (30.5%), antimicrobials (19.5%), topical excipients (19.5%), rubber accelerators (13.5%) and topical corticosteroids (8%). We also found a high prevalence of positive patch tests to Intrasite gel (9.5%) and Hioxyl cream (8.5%), medicaments which are commonly used to treat leg ulcers in our area. Contact sensitivity is common in venous leg ulcer patients and has important implications for patient management. The allergens involved vary depending on local nursing practice. We suggest that all venous leg ulcer patients be patch tested with a locally relevant patch test series.
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Affiliation(s)
- S Tavadia
- Department of Dermatology, Monklands District General Hospital, Lanarkshire, Scotland.
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