Tag Archives: Skin Allergy

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ISSN 1941-6806
doi: 10.3827/faoj.2008.0105.0007

Pediatric Atopic Dermatitis (PAD) or eczema is a term commonly used to describe inflamed, dry and itchy skin. The hallmark of the condition includes excessive skin dryness and itching causing lichenification primarily to the flexural regions of the arms and legs. The condition most commonly occurs in infants, children and young adults. The condition is particularly pruritic in nature and can be associated with other conditions such as asthma, allergic rhinitis, allergies to food and increased IgE. [1] Food allergy to eggs, milk, peanuts, soy, wheat, tomatoes, oranges, chocolate and seafood can cause PAD. [1,3] The condition is of unknown origin, but is thought to be familial in nature. The condition affects about 10 percent of children and 3 percent of the US population. [2] Onset typically begins within the first year of life in 60 percent of the cases and 85 percent within the first five years. [3] It is particularly severe in the winter months and often is referred to as “winter’s itch.” The condition most often resolves spontaneously in children as they enter adulthood.

Atopic dermatitis (AD) typically occurs in three distinct age-related stages that may be separated by periods of remission and overlap. [3]

1) In infancy to two years of age, the skin is manifested by red, weeping, crusted lesions to the face, scalp and extremities.
2) In childhood (2-12 years of age), atopic dermatitis typically appears in the skinfold areas, especially the front of the elbow, back of the knee, inside the wrist and depressions along the ankles and neck.
3) In the adult stage, from puberty onward, people with atopic dermatitis may either have a few or no skin problems since infancy, or may have suffered a chronic relapsing course with periods of remission. There are often regions of thick, red skin caused by frequent scratching. In this stage, atopic dermatitis typically appears behind the elbows and knees, on the eyelids, neck, hands and wrists.

Atopic dermatitis is not contagious. It is a genetic disorder influenced by environmental factors. The mode of inheritance and genes involved are not clear. Research shows that a family history of allergic disorders, including hay fever and asthma, significantly increases a child’s risk of developing atopic dermatititis. Children with one parent with allergies have a 30 percent risk of developing atopic dermatitis; if both parents have allergies, the risk is greater than 70 percent. [3]

Fare-ups are most common during the fall and winter when the air is dry and cool. Humid and warm weather also poses a challenge to children with atopic dermatitis. Chemicals in pools and the drying action of pool water can cause excessive skin dryness, exacerbating atopic dermatitis. Flare-ups can also be induced by skin infections, allergens and wool garments and can worsen by sudden changes in temperature and humidity or emotional stress. To minimize flare-ups, patients should avoid irritants, including soaps, solvents and other drying compounds, chlorinated water and salt water. Patients should always wear clothes that “breathe”, like cotton. [3]


Treatment of AD consists of daily skincare hydration and decreasing inflammation. Skin hydration can be achieved by applying a variety of skin moisturizers. Avoid lotions that contain water and alcohol as these tend to increase skin dryness. Patient’s suffering AD should never shower or bathe in hot water. Always wash the skin in luke warm water applying the moisturizer within three minutes of washing. This helps the moisturizer penetrate the skin up to ten times better than applying it directly to dry skin.

Special soaps can also be used including Cataphil®, Oilatum, Aveeno® and Neutrogena®. Lotions that help moisturize the skin include Eucerin®, Neutraderm, Lubriderm®, Keri®, Curel®and Moisturel®.

Children should avoid sudden changes in temperature or contact with harsh chemicals and fragrances in waters, soaps and lotions. Children should also wear breathable fabrics such as cotton to avoid flare-ups. When sleeping, avoid wool, electric and heavy blankets that may cause night sweats that can irritate AD.

Topical corticosteroid creams and sprays are the mainstay of treatment in PAD. We have found two topical corticosteroids that work the best. Clobex® spray 0.05% (clobetasol propionate) works best in areas of acute inflammation, especially in the flexural regions of the skin of the lower and upper extremities. For PAD in sensitive regions of the skin such as the face and groin, Desonide Lotion 0.05% applied twice daily works wonders.

Remember, most children will improve over time with proper treatment. It is important to keep a moisturizing treatment regime as a daily routine. If is also important to see your dermatologist or extremity skin specialist in cases of severe AD. If treatment fails, see your allergist to determine other possible allergic causes of AD.


1. Krafchik, B.R. Atopic Dermatitis eMedicine [online], 2008.
2. American Academy of Dermatology [online], 2008.
3. Iden, D.L. Facts about Pediatric Atopic Dermatitis, correspondence, 2008.

Address correspondence to: Dr. Al Kline, DPM, 3130 South Alameda, Corpus Christi, Texas 78404. E-mail: al@kline.net

Adjunct Clinical Faculty, Barry University School of Podiatric Medicine. Private practice, Chief of Podiatry, Doctors Regional Medical Center. Corpus Christi, Texas, 78411.

© The Foot & Ankle Journal, 2008

Allergic Contact Dermatitis of the Foot after use of Mastisol® Skin Adhesive: A Case Report

by Al Kline, DPM 1

The Foot & Ankle Journal 1 (2): 2

A case report describes an acute allergic contact dermatitis (ACD) to Mastisol® following foot surgery. A patch test was used to determine whether the patient was allergic to the DuraPrep™ skin prep, Steri-Strips™ or Mastisol® skin adhesive. Reaction to all patch sites with Mastisol® was observed. The contact allergy resolved within 3 to 5 days after starting oral Benadryl®, Medrol® and topical saline compresses. Initial presentation, patch testing and treatments are presented.

Key words: ACD, Allergic Contact Dermatitis, Benadryl®, Mastisol®, DuraPrep™ ,Steri-Strips™

Published online: February 1, 2008

ISSN: 1941-6806/08/0102-0002
doi: 10.3827/faoj.2008.0102.0002

Mastisol® liquid is a clear, non-irritating, non-water soluble, latex-free skin adhesive frequently used in surgery to secure skin strips for incision approximation and closure. It is produced and sold by Ferndale Laboratories of Ferndale, Michigan. Ferndale laboratories have provided Mastisol® since 1963 as a surgical adhesive. (Fig.1) The product is sold in 2/3 cc vials, 15mL and 2 oz. bottles and a 15mL spray bottle. [1] Mastisol® contains Gum Mastic, Styrax liquid, methyl salicylate and alcohol (SDA 23A). [2] The Gum Mastic and Sytrax liquid provides the tackiness and resin-like properties to the liquid.

Figure 1    Mastisol® liquid adhesive (Ferndale Laboratories)

Instructions for use include: 1) Cleaning the skin at least 2 ½ inches around the incision with saline or alcohol. 2) The blister-pak is the placed on a hard surface and the vial is broken in the blister pack. 3) The vial is then delivered using aseptic technique to the operating field. 4) The liquid is then applied 2 inches around the incision taking care not to allow the liquid to come into contact with the incision. 5) Allow 20-30 seconds of drying time and then apply uniformed tape or Steri-Strips™ in contact with the adhesive. Gauze or other materials can also come into contact with the adhesive to stabilize or dress a wound or incision. [2]

A case report is presented describing a contact allergy reaction to Mastisol®.

Case Report

A 37 year old female underwent foot surgery without a history of previous contact allergy. The patient has drug allergies to penicillin and sulfa drugs. She also has a history of childhood asthma. One day after surgery, the patient called our office to report itching and redness to the foot.

Clinical evaluation revealed significant blistering, edema and erythema to the incision sites. (Figs. 2) The patient was seen in the office with a presumptive diagnosis of acute contact allergy. Prior to surgery, the skin was prepped with DuraPrep™ solution. The patient’s subcutaneous tissue was approximated with clear Monocryl™ and the skin incision was closed with Prolene®. The skin edges were buttressed with Mastisol® and Steri-Strips.™


Figures 2  Acute contact dermatitis (ACD) following use of Mastisol® liquid adhesive.

The Steri-Strips™ were immediately removed and the foot was washed with saline. Alcohol was used to remove as much of the DuraPrep™ as possible. Treatment also included administration of oral Benadryl® 50mg every 4 hours until the pruritus stopped with saline compresses to the incision sites changed daily. The patient reported significant relief from the cool, saline compresses. A Medrol Dosepak® was also prescribed. In three to five days, the local erythema, pruritus and blistering resolved. (Fig. 3)

Figure 3  The contact allergy subsided and resolved in 3-5 days.  Oral Benadryl®, Medrol Dosepak® and topical saline compresses were ordered.  The blistering, acute erythema and pruritus have now resolved.

Patch Test

In order to determine the contact allergen causing the contact dermatitis, a patch test was performed the following week. Six sites were prepared to the patient’s back. (Table 1) Before applying the contact solutions, the back was cleansed with alcohol.

Patch Test DuraPrep™ (DP)Site 1 Mastisol® (M)Site 2 Steri-Strips™ (SS) Site 3 SS/M Site 4 SS/DP Site 5 SS/DP/M Site 6
Reactive   X   X   X
Non-Reactive X   X   X  

Table 1  All patch sites containing Mastisol® were reactive.

The six sites are listed in Table 1 and shown in Figures 4abc. Within 24 hours, the patient reported considerable ‘itching’ to the back with increased erythema, edema and weeping to the sites containing the Mastisol® skin adhesive. The sites combining the Mastisol® with the occlusive strips appeared to be more acute in nature. The sites containing only DuraPrep™ and the Steri-Strips™ were non-reactive. The same treatment protocol was prescribed with resolution of the allergy within five days.

Figures 4a  The 6 test patch sites are shown here at initial application.

Figures 4b  These are the same 6 test patch sites after 24 hours.  Notice that all the patch sites containing Mastisol® are reactive.

Figures 4c The 6 patch test sites are shown after the patches are removed.  The sites are cleansed with saline and alcohol. The patient is then placed on diphenhydramine and Medrol®.  This reaction subsided in about 3 to 5 days.


In this case, the patient experienced an acute contact allergy or contact dermatitis. The contact allergens suspected include the DuraPrep™ solution, Mastisol® adhesive and steri-strip adhesive. The Monocryl™ and Prolene® were not suspected as causing the allergy.

The patch testing confirmed our diagnosis of Mastisol® allergy. All sites (sites 2,4 and 6) containing the Mastisol® were reactive. The patches were left in place approximately 24 hours, but the patient began to have irritation within 2-4 hours of patch placement. The itching and redness was quite intense.

Once the tapes and solution was removed, the patient was placed on diphenhydramine and Medrol® and the reaction began to subside.

It is important to have epinephrine and albuterol available before performing a patch test. In our case, we knew the patient did not have true anaphylaxis, so we didn’t anticipate the need for these drugs. Preparation of the skin should include cleansing the skin with alcohol or a hypoallergenic soap and using non-allergenic tape to hold the patches in place. We applied the contact solutions and Steri-Strips™ and then covered each site with plain gauze and paper tape. Before patch testing, the patient should discontinue antihistamines and other antihistamine agents such as phenothiazine, tricyclic antidepressants, anticholinergic medications and H2 blockers such as ranitidine. [3]

Treatment protocol can vary. In milder cases of contact dermatitis, cool and warm compresses can be used. Aluminum acetate (Burow tablets) can be dissolved in water (1:40) and applied as a cool compress to give a soothing effect. [4] Soaking the foot in Domeboro® tablets mixed with water is also acceptable.

Antihistamines are primarily indicated in cases of both mild to moderate and acute contact dermatitis. 25 to 50 mg of Benadryl® or diphenhydramine can be given every 4 to 6 hours not to exceed 400mg in a 24 hour period.[3,4]  Some forms of Benadryl® tablets contain lactose, so do not give these to patients who are lactose intolerant. Alternatives to Benadryl® include H1 antagonists such as hydroxizine HCl (Atarax®, Vistaril®). [4]

Steroids such as Medrol® and prednisone are used in severe allergic reactions. In acute ACD there is marked edema and bullae. In rare cases, these bullae can get secondarily infected. Oral and systemic antibiotics are rarely required unless a secondary infection is suspected. Topical steroid creams are mentioned in the literature, but appear to be used more for the chronic forms of dermatitis.

Reports of skin allergy to Mastisol® appear to be under reported or very rare in the literature. The contact allergen could be the gum mastic, Styrax liquid or methyl salicylate. In an immediate contact allergy, when the skin is sensitized, the mast cells of the skin release histamine allowing the blood vessels to become porous. This allows fluid to accumulate in the tissues causing the tissues to weep and become swollen. The accumulation of fluid and resulting tissue edema, commonly known as a hive, also sensitize nerve endings and causes pain and pruritus or severe itching. If regions of the skin become reddened and the hives coalesce, it is termed a wheal. When this condition affects small areas of the skin, it is called utricaria. In larger regions of the skin or whole extremities, it is called angioedema.

One report in the literature described a contact allergy to Mastisol® following rhinoplasty five days after surgery. [5]

At this writing, it appears that an allergic contact dermatitis to Mastisol® is rare and should not prevent the surgeon from using the product. In my private practice, I have only seen two of these reactions requiring medical treatment in an estimated 1200 surgical cases.(0.167%)

Treatment using oral antihistamine and steroid is simple, non-life threatening and effective in every case. Certainly, if a patient is sensitive to tapes or adhesives, the product should be avoided. The patch test can be performed to determine allergy to a variety of contact allergens. In this case, the patch test confirmed the diagnosis of contact allergy to Mastisol®.


1. Mastisol®, Ferndale Laboratories, Inc. Online product description.
2. Mastisol® Instruction handout. [PDF]
3. Family Practice Notebook: Allergy Screening, [online].
4. Michael, J.A.: Contact Dermatitis, eMedicine, 2005. [online].
5. Mabrie, D.C., Papel, I.D.: An Unexpected Occurrence of Acute Contact Dermatitis During Rhinoplasty. Arch Facial Plast Surg. Vol 1, No. 4, pp. 320-321, 1999.

Address correspondence to: Dr. Al Kline, DPM, 3130 South Alameda, Corpus Christi, Texas 78404. E-mail: al@kline.net 

1 Private practice, Podiatry Staff, Doctors Regional Medical Center. Corpus Christi, Texas, 78411.

© The Foot & Ankle Journal, 2008

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