Dermatitis is a term used to describe a group of various inflammatory skin conditions. It is a common problem encountered in wound care. Dermatitis in peri-wound skin can significantly impact the patient’s quality of life and perception of pain. Patients with chronic wounds are at an increased risk of contact dermatitis. Therefore, an understanding of wound-associated dermatitis and its management is important for wound care specialists and podiatrists.

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Dermatitis In Chronic Wounds

The integrity of the peri-wound skin is an essential determinant of wound healing. Chronic wounds with excessive exudate are at an increased risk of moisture-associated skin damage. One of the complications of excessive wound exudate is contact dermatitis of the peri-wound skin. Other factors that can lead to contact dermatitis include the use of topical antibiotics, wound dressings, and other wound care materials. Therefore, it is essential for wound care specialists and podiatrists to readily identify and treat underlying dermatitis in patients with chronic wounds.

Contact dermatitis is a type of skin disorder that occurs as a result of exposure to an irritant or an allergen. The skin becomes erythematous, itchy, and burning which can cause significant discomfort to the patient. Contact dermatitis can be broadly classified into either “irritant contact dermatitis” or “allergic contact dermatitis”. The majority of contact dermatitis cases are accounted for by “irritant contact dermatitis”. It is a common occurrence in patients with incontinence and ostomies. Allergic contact dermatitis, on the other hand, results from the allergens present in wound dressing materials or other adhesive materials. 

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Management of Dermatitis In Wound Care

The incidence of allergic and contact dermatitis in wound care is a growing problem. Patients experience a significant decline in their quality of life in the presence of peri-wound dermatitis. It is important for healthcare professionals, wound care specialists, and podiatrists to be readily able to identify early eczematous skin changes as early management and treatment can improve patient outcomes. 

Regular Assessment of Periwound Skin

The skin surrounding the wound should be regularly inspected and assessed after every dressing change. A careful inspection of the wound edges should be carried out. Some of the early signs of dermatitis include red pruritic skin, increased temperature, and burning of the skin, especially after exposure to an irritant. Allergic dermatitis presents with discrete margins and might be accompanied by small, fluid-filled vesicles. It is important for healthcare professionals to readily identify and eliminate the potential trigger. A patch test can be considered if an underlying reaction to a common allergen is suspected.

Removal of Offending Agent

After the identification of the trigger factor, it should be removed. Zinc paste, petrolatum, or another skin protectant can be used if wound exudate is identified as the cause. In case dermatitis is due to an allergic reaction to a material present in the wound dressing, an alternative wound dressing should be used. The peri-wound skin should be cleansed with normal saline as certain wound cleansers can also be the cause of contact dermatitis. The presence of urine and fecal matter around peri-wound skin can be a trigger for dermatitis in patients with incontinence and stomas. Therefore, regular cleaning of peri-wound skin and the use of skin barriers should be considered in these patients. 

Treatment of Wound Infections

The presence of superimposed infection can exacerbate moisture-associated skin damage and dermatitis. Therefore, prompt recognition and treatment of wound infection are critical. Silver-impregnated wound dressings have antimicrobial properties and can be a good alternative to regular dressings. 

Management of Wound Exudate

The presence of excessive wound exudate can cause damage to peri-wound skin resulting in dermatitis. Therefore, it is essential to select appropriate wound dressing for the management of wound exudate. Highly absorbent wound dressings such as Hydrofiber and hydrocolloid are suitable for wounds with heavy exudate. Occlusive wound dressings have the potential to exacerbate moisture-associated skin damage and resulting maceration. Therefore, they should be avoided.

Compression Therapy

Patients which chronic venous insufficiency present with “stasis dermatitis” around the peri-wound skin. Local edema can exacerbate maceration and dermatitis associated with chronic venous ulcers. Therefore, compression therapy should be considered in these patients. Before initiating compression therapy, the presence of an adequate blood supply to the affected limb should be determined using the ankle-brachial pressure (ABI) index.

Pharmacological Treatment

After the offending agent has been removed from direct contact with the peri-wound skin, the pharmacological treatment for contact dermatitis should be considered. Topical corticosteroids might be prescribed along with immune response modifiers. Oral antihistamines and moisturizers are also usually given. While selecting moisturizers, ensure that they are hypoallergenic and fragrance-free.

Patient Education

Patients should be educated about the potential trigger factors and the rationale for avoiding them. In addition, patients need to be aware of the fluctuating nature of dermatitis. An absolute cure of dermatitis is not possible but it can be effectively managed using the strategies described above. Patients should also be told to avoid wearing clothing that can exacerbate itching such as wool or nylon.

Patients with chronic wounds are at an increased risk of contact dermatitis. As dermatitis can significantly impair the quality of life for patients, clinicians need to rightly identify the causative agents. Moreover, regular peri-wound skin inspections should be carried out for early recognition and management of wound-associated dermatitis. Healthcare professionals should be aware of the different treatment options available and should avoid using materials that can exacerbate existing skin problems.

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