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Wound Management
Contact Sensitivities in Chronic Wounds and the
Need for Hypoallergenic Dressings
Pauline Beldon
Tissue Viability Nurse Consultant, Epsom and St Helier University Hospitals NHS Trust
Abstract
Contact sensitivity among patients with chronic wounds, especially venous leg ulcers, is prevalent. While a vast array of wound contact
dressings and bandages exist, many of these contain potential skin-sensitising agents and should be avoided, or the skin should be
protected by an inert material. Practitioners working with patients with chronic wounds have a responsibility to heed guidance regarding
the use of simple hypoallergenic dressings wherever possible.
Keywords
Hypoallergenic, contact sensitivity, chronic wound, venous leg ulcer, allergic contact dermatitis
Disclosure: The author has no conflicts of interest to declare.
Received: 22 March 2009 Accepted: 14 April 2009
Correspondence: Pauline Beldon, St Helier Hospital, Epsom and St Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton, London, SM5 1AA, UK.
pauline.beldon@esth.nhs.uk
The last 10–15 years have seen the development of a plethora of patients with chronic venous leg ulceration run a 2.5–4.3-fold higher
wound-management products, compression bandages and hosiery risk of contact sensitisation, and also that polysensitivities were most
for the treatment of acute and chronic wounds. This has resulted in associated with patients who had had their chronic venous leg ulcer
greater choice for both practitioner and patient, and has hopefully for more than five years.
made chronic wound management more acceptable for the patient.
However, what has also become increasingly apparent over the Colophony is a common sensitiser
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that is used in many adhesive,
years is that patients with a chronic wound may also suffer with bordered dressings and some cohesive bandages. Korber et al.
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contact sensitivity to their treatment, which in severe cases may cited hydrocolloids as these dressings contain the pentaerythritol
lead to an allergic contact dermatitis (ACD). Patients with venous ester of hydrogenated rosin as the adhesive agent, which is the
leg ulceration suffer this complication, hence the addition of any substance retaining the sensitising potential of colophony, and
dressing that does not provoke a contact sensitivity is most stated that colophony was the fourth best-known sensitising agent
welcome to both patient and practitioner, and the confidence that in Germany. They reported a patient who had developed a
this brings may greatly enhance the relationship between the two. widespread area of varicose eczema after the use of a hydrocolloid
dressing for wound bed management. The clear link between
Contact Sensitivity and the chronic venous leg ulceration and the potential for contact
Venous Leg Ulcer Patient sensitivity demonstrates very clearly to practitioners that protocols
Venous leg ulcer patients have a greater tendency towards skin for the care of such patients must exclude dressings/bandages that
sensitivity/allergy than those with other chronic wound conditions.
1–6
include the most common sensitisers to minimise the risk of ACD
To demonstrate the prevalence of allergic contact dermatitis among for the patient.
the chronic venous leg ulcer population, Jankicevic et al.
1
conducted
a study in which patients with chronic venous leg ulceration were Venous leg ulcer patients have been known to have a high
compared with patients who had previously suffered from ACD. All of incidence of ACD for more than 20 years. Kulozik et al.
1
performed
the subjects were subjected to patch testing using a battery of 21 standard patch testing on 59 community-based patients with leg
standard and 22 supplemental allergens, and the results ulcers, 50.8% of whom had allergic reactions. Marasovic and´
demonstrated that 73% of patients (n=55) from the chronic venous leg Vxuksic´
4
found that patients with a venous leg ulcer were more
ulcer group and 52% of control subjects (n=43) with known ACD had likely to develop contact sensitisation than those who did not have
one or more positive patch tests, and polysensitisation was found in venous hypertension. Tavadia et al.
4
performed patch testing using
53% of subjects with chronic venous leg ulceration and 21% of the the European standard series of sensitisers, antimicrobials and
control group with known ACD. The most common allergens were medicaments on 200 venous leg ulcer patients, and 68% were
balsam of Peru (21.3%), carba mix (18.7%), fusidic acid (17.3%), found to have a positive patch test. Fifty-one per cent of these
colophony (13.3%), paraben mix (12%), chloramphenicol (12%), silver patients had multiple allergies, the most common of which were to
nitrate (12%) and neomycin (10.7%). Jankicevic et al.
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concluded that fragrances, antimicrobial agents, IntraSite Gel, Hioxyl cream, rubber
76 © TOUCH BRIEFINGS 2009
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