What Is the Role of Allergic Contact Dermatitis in Patients with Lower Leg Ulcers?

Abstract

Lower leg ulcers are a common clinical presentation to wound care clinics. They are often associated with the presence of dermatitis on the periwound skin, which can be a factor in delayed wound healing. Correctly diagnosing the underlying etiology is critical to reversing the breakdown in the skin barrier function. The author discusses allergic contact dermatitis as an etiology and describes the most common allergens, fragrances, and preservatives identified from a limited literature review. Patch testing is the criterion standard for the diagnosis of allergic contact dermatitis and is the most appropriate means of identifying causative allergens. An algorithm for the identification and treatment of lower leg dermatitis is provided to simplify the process. GENERAL PURPOSE To analyze the relationship between contact dermatitis and delayed wound healing, discuss the diagnosis and treatment of lower leg contact dermatitis, and provide an algorithm for the patient with a red leg and delayed wound healing. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Describe the nature of contact dermatitis. 2. Distinguish between allergic and irritant contact dermatitis and the other major differential diagnoses of delayed wound healing in this clinical scenario. 3. Outline the steps in the diagnosis of allergic contact dermatitis and irritant contact dermatitis and identify common haptens responsible for allergic contact dermatitis in patients with venous leg ulcers. 4. Apply the algorithm for delayed wound healing on a background of lower leg dermatitis.