ABSTRACT
Introduction: Leg ulcers are a chronic condition affecting the older population. In Singapore, the use of topical traditional Chinese medicaments (TTCM) is common amongst those older than 65 years of age. We study the role of TTCM as contact sensitisers in patients with chronic venous leg ulcers and its impact in the clinical management of these patients. Materials and Methods: Patients with chronic leg ulcers attending the Wound and Ulcer Clinic at the National Skin Centre (NSC) between October 2005 and April 2006 were patch-tested to the NSC TTCM series. They were also patch-tested for other allergens from the NSC Standard Series, Medicament Series, Steroid Series and wound dressings. Results: A total of 44 patients were patch-tested. Seventeen of the 44 (38.7%) patients were using or had used at least 1 TTCM. Seven patients (15.9%) had at least 1 positive patch test (PT) reading to TTCM, giving a sensitisation rate of 41% (7 of 17). A significantly high proportion of the patients, 94.1% (16 of 17) with a positive history of TTCM usage had at least 1 positive PT reading compared to those without a history of TTCM usage, 45.8% (11 of 24). Conclusion: TTCM play an important role as contact sensitisers in our patients with chronic venous leg ulcers and may be a significant factor in non- or poor-healing leg ulcers. In such patients, a history of TTCM usage should be sought for and patch testing should include the commonly used TTCM where relevant.
Leg ulcers are a chronic condition affecting 1% to 7% of the population above 65 years.1 Allergic contact dermatitis poses a significant problem to the healing of leg ulcers and local skin care, affecting up to 78% of patients.2-7 A recent study by our group found a high overall contact sensitisation rate of 61.4% in patients with chronic venous leg ulcers.8 The pattern of allergens involved constantly evolves according to local wound care practice. Previous studies from the West highlight aminoglycoside antibiotics, balsam of Peru, fragrance mix and lanolin alcohol as a few of the most frequent allergens.1,3,5-7
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