Allergy in phlebological patients

This study summarizes the literature on contact allergy in phlebological patients. Contact allergy is found,often voor several substances in between half and three-quarters of patients with stasis dermatitis and/or ulcus cruris. Repetitive exposure, often under occlusion, in chronically inflamed skin presumably plays a role. Positive patch test reactions occur more often in phlebological patients than in the general population,in particular to balsam of Peru up to 50%, fragrance substances more than 25%, propolis up to 5%, rubber components up to 20% and to several preservatives. More specific to phlebological treatments are is allergies to antiseptics, especially povidone iodine, benzalkonium chloride and chlorhexidine in up to a third of patients with ulcers. More than a third of all patients react to ointment ingredients such as wool alcohols. Modern wound dressings sensitize more frequently than expected (up to a quarter of patients with ulcers). The main allergens are (modified) rosin, propylene glycol, carboxymethyl cellulose and acrylates in eg. hydrogels, hydrocolloids and foils. There is regional variation in the observed allergens. Currently, allergy for compression stockings is rare due to the use of elastane and synthetic fibers instead of rubber. We recommend avoiding known allergens when treating patients with stasis dermatitis/ulcers. In case of delayed response to therapy, patch tests are advised with the European standard series and a modified Dutch "leg series". Ingredient declaration of wound dressings should be mandatory.