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Wound-related allergic, irritant dermatitis a common condition

Allergic and irritant contact dermatitis related to wound products is a common challenge that can impede healing. Clinicians should be cognizant of the allergens in these products and the potential for sensitization, according to the authors of a study published in Advances in Skin & Wound Care (2016; 29:278–286). Over recent years, the number of dressings, and wound care products has significantly increased.

“Patients with chronic wounds are frequently exposed to these products. The risk of sensitization in patients with leg ulcers varies from 46 to as high as 82.5 per cent,” said Dr. Afsaneh Alavi, who authored the report along with Dr. Gary Sibbald, Dr. Barry Ladizinski, Dr. Ami Saraiya, Dr. Kachiu Lee, Dr. Sandy Skotnicki-Grant, and Dr. Howard Maibach.

“In our report, we have outlined allergens in wound care products that have been reported in the literature over the last few years,” added Dr. Alavi, a Toronto-based dermatologist and assistant professor of dermatology, Department of Medicine (Dermatology), University of Toronto.

The researchers conducted a literature review of articles published between Jan. 2000 and Dec. 2015 on topics relating to the prevention, recognition, and the treatment of contact dermatitis among wound care patients.

Clinically, wound-associated contact dermatitis presents with localized itching, pain, and discrete or diffuse periwound dermatitis of varying severity that may delay healing or worsen the wound base and margin despite appropriate treatment, the authors wrote.

“For many reasons patients who have wounds are quite prone to contact dermatitis and clinicians treating these patients should be aware of the potential for allergic and irritant contact dermatitis,” said Dr. Alavi.

“When there are issues relating to contact dermatitis the patient might complain about a burning sensation. You will also notice that the patient’s wound is not healing and the skin around the wound is often eroded,” she said.

Allergic contact dermatitis

“Classically, there are two types of contact dermatitis consisting of allergic and irritant (more than 80 per cent), and both are possible in patients with wounds—particularly because they have impaired barrier function,” she added.

Dr. Alavi and colleagues noted in the report that allergic contact dermatitis is a delayed-type hypersensitivity often present with bright red erythema in the pattern of skin contact with the responsible allergen.

Allergic contact dermatitis is more common in patients with chronic venous insufficiency, chronic externa, postoperative or posttraumatic wounds, and chronic eczematous conditions, the authors wrote and cited (J Am Acad Dermatol 2008; 58(1):1–21).

Irritant contact dermatitis

Any chemical can be considered an irritant if it is in prolonged under occlusion contact with the skin. Irritant contact dermatitis presents clinically with irregular redness and scale on the skin surface often in a patchy distribution and may follow the gravitational path of leaked exudate, the authors wrote.

Acute irritant contact dermatitis has a rapid onset within six to 72 hours of exposure and is usually confined to the contact area, the authors reported (Community Nurse 2000; 6(8):64–68).

People with sensitive skin, pre-existing eczema, and use of occlusive dressings are more likely to develop irritant contact dermatitis to wound care products. Irritant contact dermatitis occurs from materials including adhesive tape, antiseptics, detergents, elastic bandages, and wound exudate (Nurs Times 2001; 97(35):59–62).

“It is important to differentiate between allergic contact dermatitis and irritant contact dermatitis because irritant contact dermatitis in wounds mainly happens because of excess moisture. Patch testing is the gold standard to confirm a suspected allergen,” said Dr. Alavi. “The wound exudate contains cytokines and enzymes that can damage the skin and delay healing.”

If the wound exudate is the cause, the surrounding skin can be protected with zinc paste (Nurs Times 2001; 97(35):59–62), petrolatum, a film-forming liquid acrylate, or a windowed hydrocolloid or film dressing (In Wound J 2005; 2:230–238), the authors wrote.

Wound care product labelling needed

“We have multiple wound care products available and it is important that we are aware of the ingredients and that we avoid products containing known allergens,” said Dr. Alavi.

Reaction to hydrocolloid dressings and adhesives have been reported in multiple studies. Prolonged use of topical antibiotics on the skin should be discouraged, particularly products such as polysporin and neomycin. They are known allergens and it is better to switch to a topical antiseptic that is in sterile dressings, she said.

“If the patient, however, has clean wounds and the wound is not critically colonized, then we have to avoid antiseptic and use plain wound dressings with no antibacterial.”

All medical devices, including wound dressings, adhesives, and bandages, should be labelled with their complete ingredients, and manufacturers should be encouraged to remove common allergens from wound products, including topical creams, ointments, and dressings, recommended the authors.

“There is a need for labelling all ingredients in wound care products and also the development of a more standardized patch test series for wound care products,” concluded Dr. Alavi.

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