Q:

11/5/2018
I have a 39 year-old female with grade 2 astrocytoma of T11 on chemotherapy, who has developed new-onset severe contact dermatitis to most adhesives. She has had skin sloughing off and infections requiring IV abx. She was using a TENS unit and ENSO nerve stimulator which helps with her neuro pains, but both the adhesives caused contact dermatitis. Now, she has potentially developed arrhythmias. She requires a ZIO patch or at least a holter monitor, but because of an hx of adhesive allergy to the ECG machine electrode adhesives, she is scared to use those.

My question is: What do you suggest when someone has severe adhesive contact dermatitis, but really needs temporary exposure to adhesives (ZIO patch for heart monitoring) and TENS unit or enso (for neuropathic pain relief)? If I do a patch test to random allergens, she might react to the tape, and also she denies any other sensitivity to any other contact allergens.

A:

I consulted Jonathan Silverberg, MD, PhD, MPH, Director of the Contact Dermatitis Clinic at Northwestern Memorial Hospital and Associate Professor, Departments of Dermatology, Preventive Medicine and Medical Social Sciences at Northwestern University Feinberg School of Medicine. Dr. Silverberg suggested the following approaches:

1. Use of triamcinolone (or more potent) spray that can be applied preemptively on a daily or every other day basis depending on how long the adhesive will be used and how frequently the adhesive will be changed.
2. Patch testing to commercially available adhesive allergens and/or specific adhesives of interest can be done with Finn Chamber and Telfa, though the patient could react even to the Telfa.
3. Open test to commercially available adhesive allergens and/or specific adhesives of interest can also be done if one is really concerned about irritant or allergic reactions to the tape.

Dr. Silverberg went on to state that none of these suggestions are mutually exclusive. I hope that this information is of help to you.

Jacqueline A. Pongracic, MD, FAAAAI
 

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