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A North American Study

Liliana Saap, MD; Simone Fahim, MD; Emily Arsenault, MD; Melanie Pratt, MD; Tad Pierscianowski, MD; Vincent Falanga, MD; Anita Pedvis-Leftick, MD

Arch Dermatol. 2004;140:1241-1246.

Objectives  (1) To determine the prevalence of allergen sensitivity in patients with past or present leg ulcers in 2 North American study centers vs European study findings and the North American Contact Dermatitis Group (NACDG) database and (2) to delineate a standard battery of allergens for patch testing in North American patients that is representative of the newer dressings and wound care products.

Design  Fifty-four patients, with or without dermatitis, were prospectively entered in the study. The patients were patch tested to the NACDG standard series and a comprehensive supplemental series of 52 allergens.

Setting  Wound healing clinics at Boston University Roger Williams Medical Center and University of Ottawa.

Results  Sixty-three percent (n = 34) of patients had 1 or multiple positive patch test results, and 37% (n = 20) had no positive patch test result. The most common allergens were Myroxylon pereirae (balsam of Peru) (30% [16/54]), bacitracin (24% [13/54]), fragrance mix (20% [11/54]), wood tar mix (20% [11/54]), propylene glycol (14% [7/52]), neomycin sulfate (13% [7/54]), benzalkonium chloride (13% [7/54]), carba mix (11% [6/54]), nickel sulfate (11% [6/54]), and control gel hydrocolloid (11% [6/54]).

Conclusions  Comparable to European study findings, there is a high incidence of positive patch test results in patients with past or present leg ulcerations. The incidences of the most common allergens in our patient population were higher than those seen in the NACDG, except for nickel. Using a modified leg ulcer series along with the standard NACDG series is important in evaluating patients with leg ulcers.

From the Department of Dermatology and Skin Surgery, Boston University Roger Williams Medical Center, Providence, RI (Drs Saap, Arsenault, Falanga, and Pedvis-Leftick); Department of Dermatology, University of Ottawa, Ottawa, Ontario (Drs Fahim, Pratt, and Pierscianowski); and Departments of Dermatology and Biochemistry, Boston University, Boston, Mass (Dr Falanga). The authors have no relevant financial interest in this article.