Chronic leg ulcers and contact dermatitis

Abstract

Contact dermatitis rates are high in patients with chronic leg ulcers (CLU) and impair healing, which has implications on treatment and morbidity. CLUs are repeatedly exposed to topical medications and occlusive therapies such as dressings, putting patients at risk of developing allergic contact dermatitis (ACD). Patch testing is the gold standard test to identify the causative allergens in ACD. Small international studies have found that common allergens in CLUs include benzocaine, Balsam of Peru, topical antimicrobial agents, lanolin and less frequently topical corticosteroids or rubber accelerators. The use of alternative or traditional topical medications should also be considered when assessing patients whose CLUs are not responding to prescribed treatments. Although uncommon, even 'hypoallergenic' modern, non-adherent dressings can also cause allergic contact dermatitis in CLU. Minimisation of contact with allergens is a key part of successful wound healing. Treatments for contact dermatitis includes: avoidance of allergens; restoring barrier function with liberal use of soap substitutes and emollients; and reducing inflammation with topical corticosteroid or immune response modifiers.