Summary: Ice Ross reaction
Ted A. Trower
Description
Collection
Title:
Summary: Ice Ross reaction
Creator:
Ted A. Trower
Date:
1/10/2000
Text:
My original question was:
---------------------
I have recently seen a new client who has been wearing the ICEROSS Comfort
suspension liner for some time. He states that for the first few weeks of
using a new liner he experiences severe itching that requires use of steroid
creams to control. I'm concerned that if this is indeed an allergy it may
well worsen with repeated exposure to the allergen. I've heard of this
before but not this severe. Does anyone have any ideas for a way to
pre-treat the comfort sleeve to eliminate the allergen causing this problem?
I suspect it may be the tin based catalyst used in manufacture of the
silicone but do not know this for a fact.
Responses follow, the first two responses are from Ossur staff members I
contacted through their web page.
I want to emphasize that this client has worn the ICEROSS comfort
successfully for quite some time. The problem ONLY occurs in the first few
weeks of wearing a new liner. I do not believe that his dermatitis is
related to soaps, hygiene etc.
Ted
---------------------
Dear Ted,
In response to your patient using the Iceross Comfort liner with the
itching issue, its likely he is having a reaction to the stiction of the
silicone. The term stiction is not an official term, but one I use to
describe the tackiness on the inside of a new liner. In a new Iceross it
can be helpful lightly powder the inside of the liner and wiping it out
with a lint free cloth. This will reduce or eliminate the effect that is
likely occurring with your patient.
The second issue could be the type of soap being used to clean the liner
and the patients skin. The only soaps I recommend be used are, Clean and
Simple Soap by OSSUR, Clear Ivory Liquid Soap (in a pump dispenser), or
Palmolive Dish Washing Soap for sensitive skin.
The soap and the prepowdering of a new Iceross have helped to resolve many
skin related issues for me.
Feel free to call anytime 800-423-9727.
Regards,
Greg Michalov CP
Ossur USA
---------------------
Dear Ted,
I have seen Greg Michalow's response to you and I believe his suggestion to
be a good one. The sticktion or adhesion to the skin he refers to, which
is a benefit in many cases, can cause this initial irritation. It is a
mechanical phenomena. The adhesion to the skin reduces with wear which is
the main reason why the symptoms gradually go away.
In terms of the question of allergy, it is a topic in which I am very
interested and try to keep myself informed of. I sometimes hear stories of
allergies and always try to follow them up. To date, wherever patch testing
has been carried out in a serious attempt to establish an allergy, this has
always been reported back to me as negative. I would be interested to hear
if any one else has other experiences. I have consulted the R&D department
and can confirm that there is no tin based catalyst used in ICEROSS
production so that is quite categorically not the cause.
The fact that I have personally never seen a true allergy is not to say
that skin reactions do not occur, clearly they do, but most of the time
they can be either treated or managed if the prescription of an ICEROSS is
otherwise appropriate. Our challenge as clinicians is to identify the real
cause and this is sometimes not straight forward. I believe that is why
allergy is used so extensively to describe these reactions. In reality,
in my experience it may really be a rather complex situation involving one
or more of the possible reasons.
In the literature skin reactions have been said to be divided into:
mechanical, dehydration, chemical, allergic, thermic irritation, heat,
radiation, infection or disease. My experience is that several of those
reasons are more likely to cause a skin reaction than an allergy and my own
way of approaching a skin reaction reflects that. There is a good document
related to skin and wound care which we recently commissioned and I will
ask Greg to forward that to you as soon as it is available for some more
general guidance. However, in this particular case, I would stick with his
advice. I would be interested to know your result.
Best regards,
Toby Carlsson
---------------------
Ted, I too have seen this and have had the wearer wash the liner multiple
times b/4 using and had them utilize OWW Alpha liner recommendations for
cleaning. It seems the tackiness/sheen of the new liners needs to be removed.
Al Ingersoll CP
---------------------
You may have already tried this solution, but you did not mention. All I
ever do is have the patient change to a different cleaning soap. Follow
instructions and use regular body soap to clean Iceross. If they continue to
have rash, change to non detergent type soap, such as Palmolive dish washing
soap (has worked for years). It has worked for 15 years. If you have tried
this, I will be interested in your solution. Hope this helps.
Have a wonderful year.
Friend, Jake C. P.
---------------------
I don't know how you could treat the liner if the patient is indeed allergic
to it. But we did have a patient with similar symptoms once, and I changed
liners for him. Used Alpha and Iceross and Aegis without improving the
problem, and we finally determined that the problem was that his skin
wouldn't tolerate being confined. Sure LOOKED like an allergy, but unless
he was allergic to his own sweat...
We didn't determine the exact nature of the complaint, but fitting with PTS
suspension fixed the problem, and that made me and the doc happy. Him too.
Daniel Watkins
---------------------
I to have had this trouble with a patient. It turn out she was allergic to
the mineral oil in the liner. I ended up using a TEC Liner. Be careful with
the lubricant you use with the liner because A&D also has mineral oil. My
patient used KY and Vaseline. Good luck,
Linda Mason,C.P.
---------------------
I have experienced similar reactions with patients and iceross comfort
liners, but only around the proximal edge, and it seems to clear up after 3
or 4 weeks without any medication. Hope this helps,
Regards
Arthur Graham, CP
---------------------
The little that I know of silicones has taught me that very few are truly
allergic to the material itself. Silicone has basically the same chemical
chain as glass - silica, and oxygen. Those few individuals that claimed to
be allergic to the silicone were actually having a reaction to some other
material that came in contact with their skin. Remember the old soap in
the stump sock question?
I would query the patient very closely regarding his methods of washing and
drying both his liners and his skin, also re-instruct him as to how the
liner should be properly donned - no air trapped inside. If all else fails
and he still is having problems try A & D Ointment (non-zinc based) on the
affected areas. I give sample packets of A & D to all my silicone wearers
and instruct them on the spots they should apply it. Be very specific that
they NOT use Vaseline or other petroleum jellies as they will have an
adverse affect on the silicone itself.
A last resort, and I think he will welcome the questions, call Dr. Aldo
Laghi, at ALPS South Corporation. His doctorate is in chemical
engineering. He might be able to further advise you and your patient on
finding a solution. Good luck, and let us know how you make out.
Joseph F. Carideo Jr., CP
---------------------
I would suggest trying a different make of liner, I have found the Alpha
liner to be good for sensitive skin. If this is not an option try using a
sheath between the skin and the liner; not an ideal solution but it does
work!
Terrance Bloom C.P. (c)
---------------------
have you tried with a cream called Calmuril its coming from Pharmacia Upjohn
Best Regard
Lars Falkenman
---------------------
Ted, I understand that this may be a sensitivity to the mineral oil
softeners that are inherent in the composition of such liners. Therefore
this may be untreatable However, I have had some success with the use of
a thin nylon sheath under the liner! This DOES work in some circumstances.
Richard Ziegeler P&O
---------------------
>Have you considered using the Alps liners? The easyliners aren't made with
>silicone but a gel. They now have a lockliner that is worth looking at and
>considering. This has been good to use especially when some allergies arise.
>Best of luck!
>Jeff
---------------------
Ted A. Trower C.P.O.
<Email Address Redacted>
---------------------
I have recently seen a new client who has been wearing the ICEROSS Comfort
suspension liner for some time. He states that for the first few weeks of
using a new liner he experiences severe itching that requires use of steroid
creams to control. I'm concerned that if this is indeed an allergy it may
well worsen with repeated exposure to the allergen. I've heard of this
before but not this severe. Does anyone have any ideas for a way to
pre-treat the comfort sleeve to eliminate the allergen causing this problem?
I suspect it may be the tin based catalyst used in manufacture of the
silicone but do not know this for a fact.
Responses follow, the first two responses are from Ossur staff members I
contacted through their web page.
I want to emphasize that this client has worn the ICEROSS comfort
successfully for quite some time. The problem ONLY occurs in the first few
weeks of wearing a new liner. I do not believe that his dermatitis is
related to soaps, hygiene etc.
Ted
---------------------
Dear Ted,
In response to your patient using the Iceross Comfort liner with the
itching issue, its likely he is having a reaction to the stiction of the
silicone. The term stiction is not an official term, but one I use to
describe the tackiness on the inside of a new liner. In a new Iceross it
can be helpful lightly powder the inside of the liner and wiping it out
with a lint free cloth. This will reduce or eliminate the effect that is
likely occurring with your patient.
The second issue could be the type of soap being used to clean the liner
and the patients skin. The only soaps I recommend be used are, Clean and
Simple Soap by OSSUR, Clear Ivory Liquid Soap (in a pump dispenser), or
Palmolive Dish Washing Soap for sensitive skin.
The soap and the prepowdering of a new Iceross have helped to resolve many
skin related issues for me.
Feel free to call anytime 800-423-9727.
Regards,
Greg Michalov CP
Ossur USA
---------------------
Dear Ted,
I have seen Greg Michalow's response to you and I believe his suggestion to
be a good one. The sticktion or adhesion to the skin he refers to, which
is a benefit in many cases, can cause this initial irritation. It is a
mechanical phenomena. The adhesion to the skin reduces with wear which is
the main reason why the symptoms gradually go away.
In terms of the question of allergy, it is a topic in which I am very
interested and try to keep myself informed of. I sometimes hear stories of
allergies and always try to follow them up. To date, wherever patch testing
has been carried out in a serious attempt to establish an allergy, this has
always been reported back to me as negative. I would be interested to hear
if any one else has other experiences. I have consulted the R&D department
and can confirm that there is no tin based catalyst used in ICEROSS
production so that is quite categorically not the cause.
The fact that I have personally never seen a true allergy is not to say
that skin reactions do not occur, clearly they do, but most of the time
they can be either treated or managed if the prescription of an ICEROSS is
otherwise appropriate. Our challenge as clinicians is to identify the real
cause and this is sometimes not straight forward. I believe that is why
allergy is used so extensively to describe these reactions. In reality,
in my experience it may really be a rather complex situation involving one
or more of the possible reasons.
In the literature skin reactions have been said to be divided into:
mechanical, dehydration, chemical, allergic, thermic irritation, heat,
radiation, infection or disease. My experience is that several of those
reasons are more likely to cause a skin reaction than an allergy and my own
way of approaching a skin reaction reflects that. There is a good document
related to skin and wound care which we recently commissioned and I will
ask Greg to forward that to you as soon as it is available for some more
general guidance. However, in this particular case, I would stick with his
advice. I would be interested to know your result.
Best regards,
Toby Carlsson
---------------------
Ted, I too have seen this and have had the wearer wash the liner multiple
times b/4 using and had them utilize OWW Alpha liner recommendations for
cleaning. It seems the tackiness/sheen of the new liners needs to be removed.
Al Ingersoll CP
---------------------
You may have already tried this solution, but you did not mention. All I
ever do is have the patient change to a different cleaning soap. Follow
instructions and use regular body soap to clean Iceross. If they continue to
have rash, change to non detergent type soap, such as Palmolive dish washing
soap (has worked for years). It has worked for 15 years. If you have tried
this, I will be interested in your solution. Hope this helps.
Have a wonderful year.
Friend, Jake C. P.
---------------------
I don't know how you could treat the liner if the patient is indeed allergic
to it. But we did have a patient with similar symptoms once, and I changed
liners for him. Used Alpha and Iceross and Aegis without improving the
problem, and we finally determined that the problem was that his skin
wouldn't tolerate being confined. Sure LOOKED like an allergy, but unless
he was allergic to his own sweat...
We didn't determine the exact nature of the complaint, but fitting with PTS
suspension fixed the problem, and that made me and the doc happy. Him too.
Daniel Watkins
---------------------
I to have had this trouble with a patient. It turn out she was allergic to
the mineral oil in the liner. I ended up using a TEC Liner. Be careful with
the lubricant you use with the liner because A&D also has mineral oil. My
patient used KY and Vaseline. Good luck,
Linda Mason,C.P.
---------------------
I have experienced similar reactions with patients and iceross comfort
liners, but only around the proximal edge, and it seems to clear up after 3
or 4 weeks without any medication. Hope this helps,
Regards
Arthur Graham, CP
---------------------
The little that I know of silicones has taught me that very few are truly
allergic to the material itself. Silicone has basically the same chemical
chain as glass - silica, and oxygen. Those few individuals that claimed to
be allergic to the silicone were actually having a reaction to some other
material that came in contact with their skin. Remember the old soap in
the stump sock question?
I would query the patient very closely regarding his methods of washing and
drying both his liners and his skin, also re-instruct him as to how the
liner should be properly donned - no air trapped inside. If all else fails
and he still is having problems try A & D Ointment (non-zinc based) on the
affected areas. I give sample packets of A & D to all my silicone wearers
and instruct them on the spots they should apply it. Be very specific that
they NOT use Vaseline or other petroleum jellies as they will have an
adverse affect on the silicone itself.
A last resort, and I think he will welcome the questions, call Dr. Aldo
Laghi, at ALPS South Corporation. His doctorate is in chemical
engineering. He might be able to further advise you and your patient on
finding a solution. Good luck, and let us know how you make out.
Joseph F. Carideo Jr., CP
---------------------
I would suggest trying a different make of liner, I have found the Alpha
liner to be good for sensitive skin. If this is not an option try using a
sheath between the skin and the liner; not an ideal solution but it does
work!
Terrance Bloom C.P. (c)
---------------------
have you tried with a cream called Calmuril its coming from Pharmacia Upjohn
Best Regard
Lars Falkenman
---------------------
Ted, I understand that this may be a sensitivity to the mineral oil
softeners that are inherent in the composition of such liners. Therefore
this may be untreatable However, I have had some success with the use of
a thin nylon sheath under the liner! This DOES work in some circumstances.
Richard Ziegeler P&O
---------------------
>Have you considered using the Alps liners? The easyliners aren't made with
>silicone but a gel. They now have a lockliner that is worth looking at and
>considering. This has been good to use especially when some allergies arise.
>Best of luck!
>Jeff
---------------------
Ted A. Trower C.P.O.
<Email Address Redacted>
Citation
Ted A. Trower, “Summary: Ice Ross reaction,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 23, 2024, https://library.drfop.org/items/show/213561.
