Leelavathi M, Le Yy, Tohid H, Hasliza Ah
Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia.
Asia Pac Fam Med. 2011 May 15;10(1):6. doi: 10.1186/1447-056X-10-6.
Topical antiseptics are commonly used in the management of minor wounds, burns, and infected skin. These agents are widely used by health professionals and are often self-prescribed by patients as they are easily available over-the-counter. This case illustrates a 73 year old man who presented with a non-healing wound on his right forearm for 4 weeks. The wound started from an insect bite and progressively enlarged with increasing pruritus and burning sensation. Clinically an ill-defined ulcer with surrounding erythema and erosion was noted. There was a yellow crust overlying the center of the ulcer and the periphery was scaly. Further inquiry revealed history of self treatment with a yellow solution to clean his wound for 3 weeks. Patient was provisionally diagnosed to have allergic contact dermatitis secondary to acriflavine. Topical acriflavine was stopped and the ulcer resolved after treatment with non-occlusive saline dressing. Skin patch test which is the gold standard for detection and confirmation of contact dermatitis showed a positive reaction (2+) to acriflavine. Acriflavine is widely used as a topical antiseptic agent in this part of the world. Hence, primary care physicians managing a large variety of poorly healing wounds should consider the possibility of contact allergy in recalcitrant cases, not responding to conventional treatment. Patient education is an important aspect of management as this would help curb the incidence of future contact allergies.
局部用抗菌剂常用于处理轻度伤口、烧伤和皮肤感染。这些药物被医疗专业人员广泛使用，并且由于可以在柜台轻松买到，患者也经常自行开药使用。本病例介绍了一名73岁男性，其右前臂有一个伤口持续不愈合达4周。伤口始于蚊虫叮咬，之后逐渐扩大，瘙痒和灼痛加剧。临床检查发现一个边界不清的溃疡，周围有红斑和糜烂。溃疡中心覆盖有黄色痂皮，周边有鳞屑。进一步询问得知患者自行使用一种黄色溶液清洁伤口3周。患者初步诊断为继发于吖啶黄的过敏性接触性皮炎。停用局部用吖啶黄，采用非封闭性生理盐水敷料治疗后溃疡愈合。作为检测和确诊接触性皮炎的金标准，皮肤斑贴试验显示对吖啶黄呈阳性反应（2+）。在世界的这一地区，吖啶黄被广泛用作局部抗菌剂。因此，对于处理大量愈合不良伤口的基层医疗医生而言，在遇到常规治疗无效的顽固病例时应考虑接触过敏的可能性。患者教育是治疗的一个重要方面，因为这将有助于减少未来接触过敏的发生率。
