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Contact Sensitivity in Patients with Leg Ulcerations: A North American Study

Abstract

Background: Over the last two decades, there have been a number of studies in Europe on contact sensitivity in patients with chronic leg ulcerations with a frequency of positive patch test results ranging from 40 to 82.5%. The prevalence of sensitization has not been studied in North America. Furthermore, many of the newer dressings and wound care products in the market have not been studied for contact sensitivity in patients with chronic wounds. Objectives: 1) To determine the prevalence of allergen sensitivity in patients with history of leg ulcers in two North American study centers, 2) to compare our results to the European studies and to the North American Contact Dermatitis Group (NACDG) database and 3) to help delineate a standard battery of allergens for patch testing in North American leg ulcer patients Methods: 54 patients with an active or past leg ulcer were prospectively entered in the study. The patients were patch tested to both the NACDG Standard series, as well as, a comprehensive supplemental series of 48 allergens including wound care medicaments and dressings. Results: 63% of patients were sensitized to at last one allergen. The most common allergens were Balsam of Peru (29.6%), bacitracin (24.1%), fragrance mix (20.4%), wood tar mix (20.4%), propylene glycol (13.5%), neomycin sulfate (13%), benzalkonium chloride (13%), carba mix (11.1%), nickel sulfate (11.1%) and Duoderm CGF (11.1%). Duoderm CGF was the most allergenic dressing in our study group. Conclusion: There is a high incidence of positive patch tests in patients with past or current leg ulcerations. Using a modified leg ulcer series along with the standard NACDG series is very important in evaluating patients with leg ulcers.

Allergic contact dermatitis to topical antibiotics: Epidemiology, responsible allergens, and management

“…Several studies have established that individuals with CVI have an increased rate of sensitization to any product used on the legs. 15 Prevalence rates from individual studies range from 50% to 85%, with a calculated pooled average of 67% from studies involving a total of 2631 patients with venous insufficiency (Table II). 15 (Table II).…”

“…15 Prevalence rates from individual studies range from 50% to 85%, with a calculated pooled average of 67% from studies involving a total of 2631 patients with venous insufficiency (Table II). 15 (Table II). Topical antibiotic sensitivity may be associated with ulcer duration.…”

Evaluation of contact sensitivity to topical drugs in patients with contact dermatitis

“…Bizim çalışmamızda da alt ekstremitede lezyonları olan hastalarda topikal ilaç duyarlanma sıklığı (%55,4) diğer bölgelere göre anlamlı derecede yüksek bulundu. Venöz staz ve bacak ülserli hastalarda uygulanan herhangi bir ürüne karşı AKD gelişimi sık (%50-85) olarak bildirilmektedir [18][19][20][21][22] . Bozulmuş deri bariyeri, ilacın uzamış kullanımı ve bacak ülserlerinde uygulanan oklüzif tedaviler bu hasta gruplarında AKD gelişme riskini artırmaktadır 8,23,24 .…”

“…Ülkemizden yapılan çalışmalarda neomisin duyarlılığı %2,4-2,6 olarak bildirilmiştir 45,46 . Kronik venöz yetmezliği olan kişilerde %13-34 oranında duyarlılık saptanmaktadır 18,21,47 . Yine ülkemizden Önder ve arkadaşları kronik otitis eksternalı 40 hastada en önemli duyarlandırıcının neomisin olduğunu (%15) saptanmışlardır 28 .…”

Patch testing in patients with leg ulcers with special regard to modern wound products

“…In aktuellen internationalen Studien der letzen 10 Jahre finden sich Sensibilisierungsraten von 40-82,5% [1,5,6,7,8,11,14,18,19,22,23,24]. Nur wenige Studien untersuchten im Rahmen ihrer Epikutantestung auch moderne Wundauflagen [5,13,19,24].…”