Contact dermatitis in patients with chronic leg ulcers: a common and neglected problem: a review 2000–2015
Contact allergies can occur frequently in patients with chronic leg ulcers (CLUs), even in those with a short duration of ulcerative disease. The wide spectrum of therapeutic products promotes development of the delayed type of hypersensitivity and continuous changes in the allergens pattern, which make the diagnosis and treatment extremely difficult in many cases. A prompt diagnosis and treatment of allergic contact dermatitis (ACD) in patients suffering from CLUs is very important for a best clinical outcome of these two common diseases. Thus, this review aims to highlight a common, challenging and often neglected problem.
The search included all studies published between 2000 and September 2015. Keywords used were: ‘allergic contact dermatitis leg ulcer’, ‘contact dermatitis leg ulcers’, ‘contact dermatitis wound care’, ‘contact dermatitis non-healing wounds’ and ‘contact sensitisation non-healing wounds’.
Contact allergy and polysensitisation are very frequent in patients suffering from CLUs. Although it is believed modern dressings have a lower potential for inducing cutaneous sensitisation, positive patch test reactions to modern dressings are becoming common: hydrogels, followed by hydrocolloid and the ionic silver-containing wound dressing seem to be the principal causes of ACD.
This review wanted to highlighted ACD in CLUs as a common and neglected disease whose economic and social burden has not previously been estimated, giving new insights for clinical and therapeutic management.
Chronic leg ulcers (CLUs) represent a considerable medical and social problem, affecting 1–7% of the population aged >65 years, 1–2% of the European population and 0.12–1.1% of the population worldwide.1 CLUs have different causes and can be divided into the following main categories: vascular ulcers (venous, arterial, mixed arterial/venous aetiologies), inflammatory ulcers and ulcers of atypical aetiology.2 Advanced treatments for these pathologies have led to improvements in the quality of life (QoL) of patients, facilitating a better control of bacterial burden and often leading to higher healing rates.2 A common side-effect during CLU management is the development of an allergic contact dermatitis (ACD).3,4
Genetic background, local vascular changes and environmental exposure play a key role in the development of ACD in patients affected by CLUs. Indeed, the long duration of illness, the disrupted skin barrier characterised by increased permeability, hypervascularisation and particularly the long-term use of many topical devices, such as ulcer dressings, creams, ointments, antiseptics or scented products together with occlusive bandages, promote penetration by allergens, leading to a local inflammatory skin milieu, causing the pathological development of ACD.5,6,7,8,9,10,11
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