Allergic Contact Dermatitis, Stasis Dermatitis, Teledermatology, Xeroform



  1. McKnight, Mandy
  2. Gust, Peter J.
  3. Jacob, Sharon E.


ABSTRACT: Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of lower-extremity pruritic ulcerations.


Article Content

The store-and-forward feature of teledermatology allows patient medical information (including history and visual data) obtained from one provider's location to be electronically transferred to a provider in another location (Roman & Jacob, 2015). The construct of the TeleDermViewPoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report.



Chief complaint: nonhealing legs.


History of present illness: A 57-year-old man presents with a 5-week history of very itchy lower legs that are "breaking down." He has had leg swelling for years. Present treatment: xeroform dressing and compression. Primary symptom: pruritus. Other significant laboratory/study findings: none.



Fully satisfactory.



One image was provided that shows erosive, denuded exudative plaques on the lower legs superimposed on a background of chronic eczematous changes. Notably, the exudate is bright yellow, which is consistent with a coating of bismuth tribromophenate from the xeroform.



Lesion A


The presented lesion and history are concerning for stasis dermatitis with superimposed acute contact dermatitis, possibly from the xeroform (see Figure 1).

Figure 1 - Click to enlarge in new windowFIGURE 1. Erosive, denuded exudative plaques on the lower legs.


Skin Care and Treatment Recommendations

We recommend discontinuation of the xeroform dressing and swab culture of the skin and empiric antibiotics. Recommend to start triamcinolone 0.1% ointment mixed equal parts with mupirocin ointment, twice a day to the affected area for up to 2 weeks; decrease to once a day as legs improve; and then wean off completely. Continue elevation and moderate compression therapy. Apply zinc ointment at night, and gently soak the legs in a mixture of water and acetic acid in the morning, cleanse, and apply the mixture of 1:1 triamcinolone/mupirocin.



Type of Visit

Follow up with primary care provider to initiate therapy. If no improvement within 4 weeks, refer patient for face-to-face evaluation with dermatology provider.



Stasis dermatitis is a common inflammatory skin disease that occurs on the lower extremities. It is often the earliest cutaneous sequelae of chronic venous insufficiency with venous hypertension. Zinc ointment assists in treating leg ulcerations caused by stasis dermatitis through a mechanism of reepithelialization, bacterial suppression, and inflammatory inhibition (Agren, 1990). Soaks containing 1% acetic acid, as compared with saline alone, have been shown to hasten eradication of bacteria from chronic leg wounds (Madhusudhan, 2016). About half of the patients with lower-extremity stasis dermatitis have been shown to be sensitized to chemicals contained within their treatment regimen medications, such as wool wax alcohols (lanolin), colophony, rubber additives, neomycin, and parabens (Burton, Rook, & Wilkinson, 1986; Fisher, 1986). Although xeroform impregnated gauze has been used for many years with great success for the treatment of burns, circumcisions, lacerations, lightly exudative wounds, and surgical incisions, it has notably been only rarely reported as a source of contact dermatitis (Wereide, Thune, & Hanstad, 1983). Patients may develop exuberant reactions to bismuth tribromophenate. With cessation of the inciting agent and adjunct topical and compression therapy (as was the case in the presented case), the acute dermatitis resolved. The development of allergic contact dermatitis from topical medications is a significant problem in the treatment of patients with chronic stasis and wound, of which health care professionals need to be aware.




Agren M. S. (1990). Studies on zinc in wound healing. Acta Dermato-Venereologica Supplementum, 154, 1-36. [Context Link]


Burton D. C., Rook A., Wilkinson D. S. (1986). Eczema, lichen simplex, erythroderma and prurigo. In Rook A., Wilkinson D. S., Ebling F. J. G. (Eds.), Textbook of dermatology (pp. 339-400). Hoboken, NJ: Wiley-Blackwell. [Context Link]


Fisher A. A. (1986). Contact dermatitis. Philadelphia, PA: Lea & Febiger. [Context Link]


Madhusudhan V. L. (2016). Efficacy of 1% acetic acid in the treatment of chronic wounds infected with Pseudomonas aeruginosa: Prospective randomised controlled clinical trial. International Wound Journal, 13(6), 1129-1136. doi:10.1111/iwj.12428 [Context Link]


Roman M., Jacob S. E. (2015). Teledermatology: Virtual access to quality dermatology care and beyond. Journal of the Dermatology Nurses' Association, 6(6), 285-287. [Context Link]


Wereide K., Thune P., Hanstad I. (1983). Contact allergy to xeroform in leg ulcer patients. Contact Dermatitis, 9(6), 525-526. [Context Link]


1The standardized teledermatology reader report format is available for authors on the journal's Web site ( and on the submissions Web site online at [Context Link]