colophony-induced contact dermatitis due to ecg electrodes in an infant
TRANSCRIPT
Colophony-inducedcontact dermatitis dueto ECG electrodes inan infant
Contact Dermatitis 2007: 56: 177–178
Elsbeth Oestmann, Sandra Philipp,Torsten Zuberbier and Margitta Worm
Allergie-Centrum-Charite, Klinik furDermatologie, Venerologie und Allergologie,Charite Universitatsmedizin, Berlin, Germany
Key words: allergic contact dermatitis; colo-phony; ECG; electrode; infant; patch testing.
Contact dermatitis from electrocar-diogram electrodes has been repeat-edly reported lately (1–3). Allergicand irritant origins are being dis-cussed.
Case Story
A 5-month-old female infant under-went continuous ECG monitoring athome for the prevention of suddeninfant death. Self-adhesive prewiredpaediatric monitoring electrodes(Kendall Kittycat Foam 4203; TycoHealthcare, Chicopee, MA, USA)were fixed to the chest wall. One elec-trode was used for up to 4 days.4 weeks after initial use, confluenterythematous papules developed atthe electrode sites. Similar symptomsdeveloped when using another elec-trode type (Kendall Arbo PremieH87P; Tyco Healthcare).
The contact area of both typesof Ag/AgCl electrodes is coatedwith a conductive adhesive hydrogel-contains synthetic polymers andacrylate adhesives. Patch testing withpossible contact allergens was per-formed. According to the Guidelinesof the German Contact DermatitisResearch Group (DKG), colophony
20% pet., p-tert-butylphenol-formal-dehyde resin 1% pet., propyleneglycol 20% aqueous, hydroxyethylmethacrylate 1% pet., methyl meth-acrylate 2% pet. and the adhesiveelectrodes were tested. 72-hr scoringshowed a twofold positive reaction tocolophony and positive reactions toboth sides of the first electrode andthe adhesive side of the second elec-trode. All other substances testednegative.
There was no previous history ofatopy in the infant. The mother wasknown to suffer from allergic rhinitis.
Discussion
The frequency of allergic contactdermatitis in children is often under-estimated (4). We could detect posi-tive patch test reactions to adhesiveECG electrodes due to colophony inan infant. According to the manufac-turer, colophony is not a regular partof the electrode hydrogel. However,colophony is used when solderingthe electrode cables andmetal contactplates. Long occlusive skin contactmay well dissolve the colophonyresidues within the contact gel. Asa consequence, unsoldered monitor-ing electrodes (Kendall Arbo PremieH207PGT; Tyco Healthcare) wereused for further monitoring of theinfant. The contact sites remainedunremarkable from then on. To ourknowledge, this is the first report ofan allergic contact dermatitis due tocolophony in an ECG electrode.
Propylene glycol (1) is a commontrigger of allergic contact derma-titis in adhesive ECG electrodes. Pro-pylene glycol is often part of thehydrogel. Acrylates (2) and p-tert-butylphenol-formaldehyde resin (3)could also be identified as hiddenallergens in ECG electrodes. In ourcase, no type IV sensitization to thesesubstances was detected.
References
1. Connolly M, Buckley D A. Contactdermatitis from propylene glycol inECG electrodes, complicated by medi-cament allergy. Contact Dermatitis2004: 50: 42.
2. Jelen G. Acrylate, a hidden allergen ofelectrocardiogram electrodes. ContactDermatitis 2001: 45: 315–316.
3. Avenel-Audran M, Goossens A,Zimerson E, Bruze M. Contact derma-titis fromelectrocardiograph-monitoring
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electrodes: role of p-tert-butylphenol-formaldehyde resin. Contact Derma-titis 2003: 48: 108–111.
4. Heine G, Schnuch A, Uter W, WormM. Frequency of contact allergy inGerman children and adolescentspatch tested between 1995 and 2002.Contact Dermatitis 2004: 51: 111–117.
Address:Professor Dr M. WormKlinik fur Dermatologie, Venerologieund Allergologie
Campus Charite MitteCharite Universitatsmedizin BerlinChariteplatz 1D-10117 BerlinGermanyTel: þ49 30 450 518 105Fax: þ49 30 450 518 958e-mail: [email protected]
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