Allergic contact versus irritant contact dermatitis in patients with hard-to-heal leg ulcer: clinical and diagnostic approach

J Wound Care. 2021 May 2;30(5):394-398. doi: 10.12968/jowc.2021.30.5.394.

Abstract

Background: Dermatitis of surrounding skin may complicate hard-to-heal leg ulcers, delaying wound healing. The coexistence of hard-to-heal leg ulcers and irritant or allergic contact dermatitis may create difficulties for both diagnostic and therapeutic management.

Objective: The aim of our study was to evaluate the incidence of dermatitis occurring in the surrounding skin in a population affected by hard-to-heal leg ulcers during treatment, and to differentiate between allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) with the use of a patch test. Furthermore, we investigated which medications were most probably related to these conditions.

Method: We conducted an observational study from 21 February to 21 July 2017, enlisting all patients affected by hard-to-heal leg ulcers who attended the Wound Care Service of the Dermatologic Department of ASST, Spedali Civili, Brescia, Italy.

Results: We enrolled 95 patients; 81 patients did not develop dermatitis, while 14 patients developed dermatitis of the surrounding skin. These patients underwent a patch test which gave a positive result in seven patients, permitting the diagnosis of ACD.

Conclusion: Our study confirmed the incidence of dermatitis of the surrounding skin reported in the literature but reassessed the incidence of ACD as opposed to ICD.

Keywords: allergic contact dermatitis; dressing; hard-to-heal leg ulcers; irritant contact dermatitis; ulcer; wound.

Publication types

  • Observational Study

MeSH terms

  • Bandages / adverse effects*
  • Dermatitis, Irritant / diagnosis*
  • Dermatitis, Irritant / epidemiology
  • Dermatitis, Irritant / etiology
  • Humans
  • Irritants
  • Italy / epidemiology
  • Leg Ulcer / diagnosis
  • Leg Ulcer / epidemiology
  • Leg Ulcer / therapy*
  • Wound Healing / physiology*

Substances

  • Irritants