Allergic Contact Dermatitis (ACD) to Topical Products in Orthopedic Surgery: Clinical Characteristics and Treatment Strategies

نویسندگان

1 1 SINY Dermatology, Brooklyn, NY, USA 3 Department of Dermatology, NYU Langone Medical Center, New York, NY, USA

2 Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain

3 SINY Dermatology, Brooklyn, NY, USA

4 Montefiore Medical Center - Department of Orthopedic Surgery, New York, USA

5 Montefiore Medical Center - Department of Orthopedic Surgery, New York, USA

doi
10.22038/abjs.2023.70444.3303
چکیده

The potential for many of the commonly used surgical site wound adhesives, skin antiseptic solutions, topical antibiotics, and suture materials to sensitize and subsequently result in allergic contact dermatitis (ACD) has become increasingly recognized within orthopedic surgery. Particularly with subsequent exposure to the offending allergen, the cutaneous allergic reaction may present in a similar fashion to cellulitis, thus making early differentiation between the two etiologies to initiate the appropriate and timely treatment crucial. Recognition of the characteristic appearance and severity of ACD surrounding a surgical wound often drives the initial management. This typically consists of anti -histamines, topical corticosteroids, and possible removal of the offending allergen for low grade findings and oral steroids and prophylactic oral antibiotics for the more severe reactions. Multidisciplinary care, including the expertise of a dermatologist or wound care specialist when faced with this challenging clinical scenario is critical and elective patch testing may be indicated to ascertain the exact allergen involved, particularly in patients with a prior history of wound issues. Finally, any clinical cases of ACD following an orthopedic procedure should be documented in the patient’s chart so that exposure can be avoided with any future surgery.  Level of evidence: III