Cutaneous reactions to surgical preparations and dressings

Allergic Contact Dermatitis to Operating Room Scrubs and Disinfectants

BACKGROUND

Both surgical personnel and patients undergoing procedures are exposed regularly to different antiseptic chemicals in various forms. Little is known about the ingredients in these antiseptics and the risk these products may provoke allergic contact dermatitis.

OBJECTIVE

The aim of the study was to identify and characterize common allergens in surgical scrubs and patient surgical cleansers that health care workers and surgical patients may encounter in the perioperative period.

METHODS

DailyMed website was searched using numerous terms for surgical disinfectants. Products used for health care worker handwashing/scrubbing or patient surgical cleansing/disinfecting were included. Each product's ingredients were recorded; those found on the 2017 American Contact Dermatitis Society (ACDS) Core Allergen Series were noted from each product.

CONCLUSIONS

A total of 1940 products were identified, of which 267 were included in the analysis. A total of 66.3% contained iodine, 25.8% contained chlorhexidine digluconate, and 2.6% contained chloroxylenol. Within the group analyzed, 1586 ingredients were identified. Of these, 241 were ACDS Core Series allergens. Most products contained a single ACDS allergen. There were significant differences in allergens based on product type and active ingredient, with iodine-containing products having the fewest number of allergens. The most common ACDS allergens found were cocamide diethanolamide (22.5%), fragrance (21.7%), lanolin (19.5%), propylene glycol (6.7%), alkyl glucosides (6.0%), and sorbic acid derivatives (5.6%).

A dynamic landscape of allergen associations in delayed-type cutaneous hypersensitivity

BACKGROUND

Delayed-type hypersensitivity represents a significant clinical and public health challenge. Patients undergoing patch testing may exhibit positive reactions to more than one allergen. It is recognized that reactions to specific pairs of allergens are associated, reflecting a combination of exposure patterns and structural similarity.

OBJECTIVES

To explore the influence of time of testing, age, sex and atopy status on allergen pair associations in a series of 45 110 consecutive patients tested over 30 years.

METHODS

Patch test records of all patients undergoing testing with a modified European baseline series between 1985 and 2014 were retrieved from a database at St John's Institute of Dermatology. Reactions were read on days 2 and 4. For each allergen it was recorded whether the allergen was tested and whether the result was positive or negative.

RESULTS

This is the largest reported study of patch test allergen pair relationships. Our analysis shows a high degree of variability in allergen pair associations. Rigorous statistical analysis reveals a large number of differences between groups, including a significant increase in the association between formaldehyde and multiple formaldehyde-releasing preservatives over the study period, in addition to pair associations with cobalt and formaldehyde-releasing preservatives. These were present to a significantly greater extent in men than in women.

CONCLUSIONS

These observations extend our understanding of cutaneous allergy, with implications for both clinical practice and mechanisms of cutaneous hypersensitivity.

Compound tincture of benzoin: a common contact allergen?

The results of patch testing to compound tincture of benzoin in 477 patients performed at the Contact Dermatitis Clinic at the Skin and Cancer Foundation in Melbourne during 1999 are presented. There have been fewer than 30 reported cases of contact allergy from compound tincture of benzoin, and none in the last decade. Our results showed 45 out of the 477 patients had a positive reaction to compound tincture of benzoin, which was the third most common allergen in our series. Of these 45 patients, 14 had strong positive reactions, but only two definitely recalled exposure to compound tincture of benzoin and these were clinically relevant. Twenty-eight of these patients had cross-reactions to similar allergens (fragrance mix, balsam of Peru, colophony and tea tree oil). Of the 14 patients with a strong positive reaction to compound tincture of benzoin, 11 had at least one other positive cross-reaction to the above allergens. This may explain the high frequency of reaction to compound tincture of benzoin found in our study.

Leg ulcers

The treatment of leg ulcers is a common and sometimes difficult problem. They can be costly to treat and are associated with loss of working capacity and sometimes significant morbidity. In the western world, leg ulcers are most frequently caused by venous insufficiency, arterial insufficiency, neuropathy (usually diabetic), or a combination of these factors. The pathogenesis, clinical features, and management of these types of leg ulcers are emphasized in this review.

Cutaneous tissue repair: practical implications of current knowledge. II

This article reviews the scientific basis for the certain factors that delay wound repair in the clinical setting. A brief history of wound healing is given, followed by a discussion of endogenous local factors (bacterial infection, hypoxia, foreign body, and desiccation) and endogenous systemic factors (nutritional deficiencies, aging, coagulation disorders, and the Ehlers-Danlos syndromes) associated with poor wound repair. Also reviewed are the mechanisms by which exogenously administered agents (glucocorticoids, antineoplastic agents, and anticoagulants) may delay healing. Commonly used topical antimicrobials, their spectrum of activity, and evidence of effects on wound healing are examined. Finally, properties of commercially available wound coverings and wound care in the future are discussed.

Allergic contact dermatitis from povidone-iodine

A patient developed an erythematous papular, vesicular rash after application of povidone-iodine 10% solution used as a surgical antiseptic. Patch testing revealed positive responses to povidone iodine 10 and 5% in water; 25 controls were negative. Patch testing with iodine, 0.5% in ethanol gave negative results.