Contact Allergies in Patients with Leg Ulcers

Revathi, K (2015) Contact Allergies in Patients with Leg Ulcers. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.


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INTRODUCTION: Leg ulcers are chronic conditions with prolonged courses and refractory healing. Multifaceted treatment is needed for the management of leg ulcers like proper wound care practices, compression therapy and surgical procedures. Chronic leg ulcers are common disease which affects 0.12% to 1.1% of world population and non healing ulcer with dermatitis is a common problem. Since the time duration is longer for the management of leg ulcers, the patients are exposed to many topical medicaments and medicaments incorporated dressing. Application of these medicaments to the barrier disrupted skin lead to contact sensitisation to these substances. Contact sensitisation will lead to allergic contact dermatitis of the skin surrounding the leg ulcers. Allergic contact dermatitis of the surrounding skin, in turn, can impede the healing of ulcers and restrict the choice of treatment. In already sensitized leg ulcer patients, allergic contact dermatitis can develop at the sites other than legs due to direct allergens exposure, dissemination from ulcer site, or systemic spread.3 In India, patients tend to use topical medicaments injudiciously and frequently because topical medicaments are available over the counter. So chances of contact allergy are more in our country. AIMS AND OBJECTIVES: 1 To determine the frequency of contact sensitization in patients with leg ulcers using a leg ulcer patch test series. 2. Revealing the associations between chronic leg ulcers and contact sensitization. MATERIALS AND METHODS: Study design: This study was done as a hospital based descriptive, observer blinded study. Study Population: Chronic leg ulcer patients aged 18 years and older, male or female, attending the Dermatology OP were included in the study. A total of 50 patients with chronic leg ulcers with or without surrounding dermatitis due to various causes is selected. Study Period: This study was done during a period of 18 months after obtaining clearance from the ethical committee. Written informed consent was taken from all patients involved in our study. Inclusion Criteria: 1. 50 chronic leg ulcer patients with or without surrounding dermatitis were included in this study. Exclusion Criteria: 1. Patients are having acute skin eruptions on the back. 2. Patients are taking oral corticosteroids more than 20mg per day. 3. Patients on any other immunosuppressant’s. 4. Pregnant and lactating mother. 5. Age <18 years. METHODS: 1. 50 patients with chronic leg ulcer were recruited and informed consent was obtained. 2. Detailed history and clinical examination was performed (enclosed in proforma) 3. The leg ulcer series is obtained from chemo technique which consists of 28 allergens. These allergens were applied on finn chambers and were strapped to the back of the patients with tapes. 4. The patches must stay in place undisturbed for at least 48 hours. vigorous exercise, stretching, shower and sun light exposure should be avoided. 5. After 48 hours, the finn chambers were removed and the squares representing each chamber were marked using a marker pen. 6. Readings were taken after half an hour and again second reading were taken at 72 hours. CONCLUSION: Our study showed a high rate of contact sensitization in leg ulcer patients. Most common allergens in our study were 4-chloro 3-creso l (preservative in steroid creams), wood tar mix (cosmetic related to balsum of peru), framycetin sulphate (antimicrobial) followed by benzalkonium chloride (disinfectant) and thiomerosal (preservative, antiseptic). Percentage of positive allergens reflects the local wound care practices for leg ulcer, particularly the use of topical steroids and antimicrobial. By avoiding that particular allergen we can prevent secondary sensitization which will promote the wound healing. So we recommend patch testing for leg ulcer patients with or without dermatitis, so as to prevent delayed wound healing.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Contact Allergies ; Patients ; Leg Ulcers.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Punitha K
Date Deposited: 05 May 2018 10:09
Last Modified: 05 May 2018 10:10

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