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Adhesive allergy - low dye tape?

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  #1  
Old 3rd May 2012, 11:48 PM
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Default Adhesive allergy - low dye tape?

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good morning all,

ok, so i have a pt who has had great relief from her problem using low dye strapping. however, the issue here is that she reported sensitive skin so the first time, i sprayed some opsite on the area before applying the tape with the aim of giving some protection...failed...so then tried other tapes under the low dye tape (mefix and hapla band) both also failed to protect her against irritation...in fact, despite advising her to remove the tape if ANY irritation occurs, she didnt and now has areas of itchy broken skin

so my question to you all is...does anyone know of a tape that does the same or similar job of low dye strapping but without the issue of allergies? any other suggestions on overcoming this issue are welcomed

thanks!
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Old 7th May 2012, 08:17 PM
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Default Re: Adhesive allergy - low dye tape?

what's the pathology you're treating? could you achieve the same thing with an orthoses?

problem solved
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Old 8th May 2012, 01:06 AM
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Default Re: Adhesive allergy - low dye tape?

hi Phil,

this lady has a chronic and disabling Haglunds Deformity. Footwear issues are trying to be addressed and she has been to see 2 surgeons...both who are reluctant to carry out surgery...seems there is a retrocalcaneal spur (on x-ray) but i havent had access to this. anyway, trying to deal with the symptoms, i tried some compression using the low dye strapping along with ice therapy to reduce any inflammation at the site. the lady phoned the next day to say that she was amazed that she could actually walk with this tape in place...magic!

not sure what orthoses might benefit this if any...? really, its mostly down to the powers of persuasion on my part to get her to change footwear if conservative management is going to reduce pain during gait. she has a job in a wedding dress shop so standing and pretty shoes are important to her...any suggestions are most welcome!

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Old 8th May 2012, 02:43 AM
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Default Re: Adhesive allergy - low dye tape?

Quote:
Originally Posted by poppet View Post
good morning all,

ok, so i have a pt who has had great relief from her problem using low dye strapping. however, the issue here is that she reported sensitive skin so the first time, i sprayed some opsite on the area before applying the tape with the aim of giving some protection...failed...so then tried other tapes under the low dye tape (mefix and hapla band) both also failed to protect her against irritation...in fact, despite advising her to remove the tape if ANY irritation occurs, she didnt and now has areas of itchy broken skin

so my question to you all is...does anyone know of a tape that does the same or similar job of low dye strapping but without the issue of allergies? any other suggestions on overcoming this issue are welcomed

thanks!
poppet
Hi Poppet

See you if you can get your hands on some Fryars Balsam (tincture of Benzoin compound). This stuff is old school antiseptic and smells pretty ordinary, but it is really effective at preventing skin irritation under adhesive tape.

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Old 8th May 2012, 04:42 AM
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Default Re: Adhesive allergy - low dye tape?

Quote:
Originally Posted by poppet View Post
hi Phil,

this lady has a chronic and disabling Haglunds Deformity. Footwear issues are trying to be addressed and she has been to see 2 surgeons...both who are reluctant to carry out surgery...seems there is a retrocalcaneal spur (on x-ray) but i havent had access to this. anyway, trying to deal with the symptoms, i tried some compression using the low dye strapping along with ice therapy to reduce any inflammation at the site. the lady phoned the next day to say that she was amazed that she could actually walk with this tape in place...magic!

not sure what orthoses might benefit this if any...? really, its mostly down to the powers of persuasion on my part to get her to change footwear if conservative management is going to reduce pain during gait. she has a job in a wedding dress shop so standing and pretty shoes are important to her...any suggestions are most welcome!

poppet
but that's the question, how is the lowdye strapping reducing her symptoms? Is it by reducing rearfoot eversion and it's effect on the achielles? cause you could do that with an orthoses, couldn't you?

But if it's by compressing the posterior heel to limit swelling, could you just stick a piece of that kinetic tape around the posterior heel? Do you know what it is? Its more stretchy, physios use it lots. I don't think it uses zinc as the adhesive, which is probably what she's reacting to.

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Old 8th May 2012, 05:17 AM
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Default Re: Adhesive allergy - low dye tape?

hi,

i did read about the friars balsm trick...so might try this...also thought about adding some deflective padding (SCF) to the footwear (if there is room) which will along with other elements of RICE will aim to reduce any inflammation to what i suspect is a retrocalcaneal bursitis at the site. the tape was aimed at compression, but also i would assume that by restricting dorsiflexion this would effectivly reduce irritation to the area? it is very difficult to assess this lady's gait at the moment due to the antalgic gait so at this point, i would be hesitant to prescribe orthoses to avoid further complications.

some interesting points here though. it is often usful to mull things over with others to enable us to see the wood for the trees

thanks
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Old 8th May 2012, 03:56 PM
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Default Re: Adhesive allergy - low dye tape?

If the Low Dye strapping is having beneficial effect on the Haglunds/retrocalcaneal bursitis/spur issue via reducing Calcaneal eversion - then why not try just a simple rear foot varus wedge which will/should reduce Calcaneal eversion &/or place the Haglunds bump in a happier position. I have in the past also addressed the footwear - putting aside the need for more foot sensible footwear, you can also modify the current footwear. Usually with this scenario there will be some wearing on the heel counter of shoe where the pressure/rubbing is taking place. Get out your nail drill & bore a deflective aperture for the Haglunds bump to sit in – thus offloading pressure area. This may be a better long term solution. Both above solutions are quick, cheap & effective within a one consult appointment. I love the Low Dye strapping technique but it can be a nuisance for patients reapplying for long term - let alone the skin irritation in this case.
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Old 8th May 2012, 11:41 PM
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Default Re: Adhesive allergy - low dye tape?

i think i will get the lady to come back in with a few pairs of shoes to evaluate what we can do in this regard, however, i have only, so far, seen her in a ballet pump style shoe which has little scope for burring out an aperture...nice idea long term though. might try the scf before taking a burr to her shoes mind

will also look at the wedge idea too...thanks to all...keep the suggestions coming...all helps as i am sure that other would be able to use this info to apply to other pts in the future.

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Old 16th May 2012, 02:31 AM
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Default Re: Adhesive allergy - low dye tape?

Hello Poppet,

I am allergic to zinc oxide strapping tape myself, but so far have found the best solution is to apply a liberal coating or two of Friars balsam, then a layer of hypafix or similar product to all areas where ZO tape will be applied. Then apply the ZO tape. I have used this technique on many patients with "allergies" to tapes with good results and found myself that it works well on my own skin.
Hope this helps you.
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Old 16th May 2012, 04:35 AM
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Default Re: Adhesive allergy - low dye tape?

sounds good to me!

i will try this out along with other options as and when this lady returns to see me.

thank you
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Old 7th May 2013, 05:55 PM
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Default Re: Adhesive allergy - low dye tape?

I applied Friars Balsam to the skin then applied a low-dye strapping to a patient with plantar fasciitis. This was the 2nd time I applied it with the first application causing no issues at all (& I have used this same process on him 12 months ago with no issues). He returned for a review & he has had a SEVERE reaction to the tape (or Friars Balsam). When he removed the tape it appears to have torn the skin in almost strips. I arranged for him to see his GP immediately for antibiotics & dressings & he is also using crutches. It is quite worrying. I have contacted the tape supplier just to check if the tape is any different to what I have been supplied in the past.

Last edited by Zac : 7th May 2013 at 06:20 PM. Reason: Posted twice
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Old 7th May 2013, 06:08 PM
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Default Re: Adhesive allergy - low dye tape?

I applied Friars Balsam to the skin then applied a low-dye strapping to a patient with plantar fasciitis. This was the 2nd time I applied it with the first application causing no issues at all (& I have used this same process on him 12 months ago with no issues). He returned for a review & he has had a SEVERE reaction to the tape (or Friars Balsam). When he removed the tape it appears to have torn the skin in almost strips. I arranged for him to see his GP immediately for antibiotics & dressings & he is also using crutches. It is quite worrying. I have contacted the tape supplier just to check if the tape is any different to what I have been supplied in the past.

Have I missed something? He has no known allergies. And I have used the tape & Friars Balsam on him in the past. Can Friars Balsam make the tape adhere too well???
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Old 7th May 2013, 06:41 PM
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Default Re: Adhesive allergy - low dye tape?

Quote:
Originally Posted by Zac View Post
I applied Friars Balsam to the skin then applied a low-dye strapping to a patient with plantar fasciitis. This was the 2nd time I applied it with the first application causing no issues at all (& I have used this same process on him 12 months ago with no issues). He returned for a review & he has had a SEVERE reaction to the tape (or Friars Balsam). When he removed the tape it appears to have torn the skin in almost strips. I arranged for him to see his GP immediately for antibiotics & dressings & he is also using crutches. It is quite worrying. I have contacted the tape supplier just to check if the tape is any different to what I have been supplied in the past.

Have I missed something? He has no known allergies. And I have used the tape & Friars Balsam on him in the past. Can Friars Balsam make the tape adhere too well???
Zac:

Tincture of benzoin (Friar's Balsam) is a known cause of contact dermatitis. My guess it is the tincture of benzoin your patient is getting the dermatitis from, not the tape.

Quote:
Australas J Dermatol. 2003 Aug;44(3):180-4.

Compound tincture of benzoin: a common contact allergen?

Scardamaglia L, Nixon R, Fewings J.

Abstract

The results of patch testing to compound tincture of benzoin in 477 patients performed at the Contact Dermatitis Clinic at the Skin and Cancer Foundation in Melbourne during 1999 are presented. There have been fewer than 30 reported cases of contact allergy from compound tincture of benzoin, and none in the last decade. Our results showed 45 out of the 477 patients had a positive reaction to compound tincture of benzoin, which was the third most common allergen in our series. Of these 45 patients, 14 had strong positive reactions, but only two definitely recalled exposure to compound tincture of benzoin and these were clinically relevant. Twenty-eight of these patients had cross-reactions to similar allergens (fragrance mix, balsam of Peru, colophony and tea tree oil). Of the 14 patients with a strong positive reaction to compound tincture of benzoin, 11 had at least one other positive cross-reaction to the above allergens. This may explain the high frequency of reaction to compound tincture of benzoin found in our study.
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Old 7th May 2013, 06:50 PM
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Default Re: Adhesive allergy - low dye tape?

Thanks Kevin. That's really interesting. I have used it intermittently for 10 years & don't recall every seeing a reaction. I use it partly to improve adherence & Id been told it was helpful to reduce reaction from the tape.
This poor fellow has suffered terribly from the tape & so concerned to try & find out what may be the culprit. As I said, I have used it on him in the past with no issues. The body is a perculiar thing.
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Old 7th May 2013, 06:59 PM
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Default Re: Adhesive allergy - low dye tape?

Quote:
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Thanks Kevin. That's really interesting. I have used it intermittently for 10 years & don't recall every seeing a reaction. I use it partly to improve adherence & Id been told it was helpful to reduce reaction from the tape.
This poor fellow has suffered terribly from the tape & so concerned to try & find out what may be the culprit. As I said, I have used it on him in the past with no issues. The body is a perculiar thing.
Zac:

In 28 years of practice, I have seen a severe reaction to tincture of benzoin (like your patient) two times and have seen milder reactions about 20 times. It is not very common but, once you have seen it once, there is no mistaking it the second time you see it!
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Old 7th May 2013, 07:05 PM
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Default Re: Adhesive allergy - low dye tape?

Thanks again Kevin. When do you use FB?
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Old 7th May 2013, 07:21 PM
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Default Re: Adhesive allergy - low dye tape?

Quote:
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Thanks again Kevin. When do you use FB?
I use tincture of benzoin when applying low-dye straps/foot strappings and when applying Steri-strips to surgical incisions with a running subcuticular stitch.
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Old 7th May 2013, 07:24 PM
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Default Re: Adhesive allergy - low dye tape?

Sorry Kevin, I should have been more specific. Do you use it for every strapping patient (except those with an allergy to FB)? Are you using it primarily to increase the adherence of the tape or reduce any possible reaction to the tape?
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Old 7th May 2013, 07:32 PM
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Default Re: Adhesive allergy - low dye tape?

Quote:
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Sorry Kevin, I should have been more specific. Do you use it for every strapping patient (except those with an allergy to FB)? Are you using it primarily to increase the adherence of the tape or reduce any possible reaction to the tape?
I use it only to increase skin adherence of the tape, except in known allergic patients.
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Old 7th May 2013, 10:51 PM
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Default Re: Adhesive allergy - low dye tape?

I hate to take up too much of your time Kevin, but how serious were the reactions of your "severe" patients? My gentleman has some vesicular dermatitis with painful hemorrhagic bullae - these have burst & have left some very painful, raw tissue under the medial arch.
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Old 8th May 2013, 12:20 PM
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Default Re: Adhesive allergy - low dye tape?

Quote:
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I hate to take up too much of your time Kevin, but how serious were the reactions of your "severe" patients? My gentleman has some vesicular dermatitis with painful hemorrhagic bullae - these have burst & have left some very painful, raw tissue under the medial arch.
That sounds about like what happened to one of my patients. He couldn't wear shoes for a month due to the rash and blisters. I would refer him to a dermatologist to make sure he is getting the best treatment. Just reassure him that he will eventually get better in a few weeks.
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Old 12th May 2013, 10:33 PM
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Default Re: Adhesive allergy - low dye tape?

This is an image of the patients for after strapping &/or Friars Balsam reaction.
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Old 12th May 2013, 10:36 PM
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Default Re: Adhesive allergy - low dye tape?

The same patient one week post allergy. Treatment included Antibiotics (for Staph Aureus & Pyogenes), silver dressings, rest & non-weightbearing.
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Old 13th May 2013, 07:13 AM
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Default Re: Adhesive allergy - low dye tape?

Zac:

Nice photos. These photos are a good reminder about the potential of skin reactions with Tincuture of Benzoin. Not very common, but they do happen, and, sometimes, quite seriously.
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