Wound-Related Allergic/Irritant Contact Dermatitis.

PURPOSE: To provide information from a literature review about the prevention, recognition, and treatment for contact dermatitis. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Identify signs and symptoms of and diagnostic measures for contact dermatitis.2. Identify causes and risks for contact dermatitis.3. Select appropriate treatment for contact dermatitis and its prevention. ABSTRACT: Contact dermatitis to wound care products is a common, often neglected problem. A review was conducted to identify articles relevant to contact dermatitis.A PubMed English-language literature review was conducted for appropriate articles published between January 2000 and December 2015.Contact dermatitis is both irritant (80% of cases) or allergic (20% of cases). Frequent use of potential contact allergens and impaired barrier function of the skin can lead to rising sensitization in patients with chronic wounds. Common known allergens to avoid in wound care patients include fragrances, colophony, lanolin, and topical antibiotics.Clinicians should be cognizant of the allergens in wound care products and the potential for sensitization. All medical devices, including wound dressings, adhesives, and bandages, should be labeled with their complete ingredients, and manufacturers should be encouraged to remove common allergens from wound care products, including topical creams, ointments, and dressings.

Airborne allergic contact dermatitis from tylosin in pharmacy compounders and cross-sensitization to macrolide antibiotics.

Tylosin is a broad-spectrum macrolide antibiotic that is restricted to veterinary use. Allergic contact dermatitis (ACD) caused by tylosin has been reported in the literature from the farming industry and veterinary medicine. It is also reported as the most common antibiotic to cause ACD in the previously mentioned occupational settings. We present 2 cases of airborne ACD from tylosin among veterinary pharmaceutical compounding technicians. To our knowledge, only one other case of patch test-confirmed tylosin ACD has been reported in the manufacturing setting. Based on our results, cross-sensitization to other clinically relevant macrolides does not appear to be a concern. Our cases highlight the importance of patch testing among pharmaceutical compounders where the incidence of an airborne contact may be greater, given that the exposure is to the powdered form of potential allergens.

Repeated mechanical trauma to the hands: the use of anti-impaction gloves for treatment and return to work.

BACKGROUND: Repeated mechanical trauma to the hands can result in frictional hand dermatitis (FHD) and (in some cases) hyperkeratotic hand dermatitis (HHD), forms of irritant contact dermatitis. These conditions can be chronic and debilitating and are often refractory to many therapies. Most case reports of FHD describe avoidance of frictional trauma as a management solution. This is the first study to examine anti-impaction gloves as a treatment for FHD. OBJECTIVE: To determine whether anti-impaction gloves are effective in helping patients with FHD and HHD return to work. METHODS: We describe a small case series of a subset of patients who presented to our occupational contact dermatitis clinic between January 2004 and June 2008 with either HHD or FHD. Of the 11 patients evaluated, 9 had a diagnosis of FHD and 2 were diagnosed with HHD. They were all treated with anti-impaction gloves, tazarotene cream (Allergan, Inc., Irvine, CA), and clobetasol propionate ointment (Taro Pharmaceuticals Inc., Brampton, Ontario, Canada) and were followed over the long term to determine the impact of treatment on their ability to maintain their jobs. All but one began use of anti-impaction gloves in the workplace. RESULTS: All patients with FHD were able to return to work with the use of anti-impaction gloves, topical treatments, and (in some cases) modified work duties. Neither of the two cases of HHD resolved with treatment or with discontinuation of work. CONCLUSION: Anti-impaction gloves are shown to aid in the return-to-work process for those with FHD but not for those with HHD.

Allergic contact dermatitis from formaldehyde textile resins in surgical uniforms and nonwoven textile masks.

Despite a trend for reduction in the concentration of free formaldehyde in textiles, formaldehyde textile resin (FTR) allergic contact dermatitis (ACD) remains an important clinical issue and is likely underdiagnosed. Patients with FTR ACD may react to formaldehyde released from the resin or to the resin itself. Screening with formaldehyde and ethyleneurea/melamine formaldehyde resin will uncover most cases. Patch testing with the suspected offending fabric most often leads to false-negative results. We present a case of a 49-year-old pediatrician who developed a severe widespread dermatitis caused by contact with FTRs from her hospital "greens" ("scrubs") and mask.

A systematic review of contact dermatitis treatment and prevention.

BACKGROUND: Contact dermatitis (CD) is a common occupational disease. There have been no systematic reviews of CD treatment or prevention. METHODS: Multiple databases were systematically searched. Using independent double review and published quality review criteria, articles were rated as good, fair, or poor. Treatment benefit data were tabulated and conclusions were based on the rated strength of published evidence. RESULTS: In all, 49 studies met inclusion criteria. Barrier creams containing dimethicone or perfluoropolyethers, cotton liners, and softened fabrics prevent irritant CD. Lipid-rich moisturizers both prevent and treat irritant CD. Topical skin protectant and quaternium 18 bentonite (organoclay) prevent rhus dermatitis. Diethylenetriamine pentaacetic acid (chelator) cream prevents nickel, chrome, and copper dermatitis. Potent or moderately potent steroids effectively treat allergic CD. There were no macrolide immunomodulator trials that met inclusion criteria. This review did not include studies of children, animals, or non-English language publications. CONCLUSIONS: A limited number of interventions effectively prevent or treat irritant and allergic CD, but well-controlled, outcome-blinded studies, particularly in the area of allergic CD prevention are needed.