Suspension Liners and Skin Rashes - Summary 3

Suspension Liners and Skin Rashes - Summary 3

Custom Prosthetic Services Ltd.

5/17/2001

I have compiled the third summary of responses to the discussion
surrounding the issue of cholinergic urticaria and other skin reactions
involving the use of suspension liners and sleeves. Additional comments
or questions are most welcome, in the interest of furthering knowledge
in this area.

Geoffrey Hall, B.Sc., C.P. ( c )
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I am an English amputee of 43 years experience, now since Christmas
using a
below knee limb fitted with a suction valve and using an ALPS sheath and
an
ALPS suspension sleeve. At times I develop a severe rash with weals and
welts and raised lumps and spots. It does not go away after 4 hours! It
lasts several days. Scrupulous hygeine is in any event necessary with
this
system, and what I do when an attack happens is to wash the stump in non
allergenic soap several times daily and resort to hydrocortisone cream
which
is available over the counter in the UK. Normal antiseptic creams do not
help. The rash and reaction happen randomly perhaps once or twice a
month.
The feeling is uncomfortable and hot, even itchy. I play 18 holes of
golf
two or three times weekly. Hope my observations help.
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Thanks very much for your informative post to the oandp list. The detail
of
your investigation into your clients symptoms is very refreshing and, I
think, appropriate. Often symptoms such as these are dismissed as an
allergic reaction, incorrectly so, ultimately leading to withdrawal of
that
particular interface. Some liners do indeed exhibit different surface
properties and behave quite differently when compared to others. But
without doubt, I do feel that 'socket fit' is also a major issue, along
with choice of an appropriate interface and indeed the correct size of
interface.

We have much experience with users having heat related problems. Without
doubt, new users will experience increased levels of perspiration during
the early stages of interface use. It's also reasonable to suggest to
the
user that these symptoms, in the majority of cases, will subside over
the
coming weeks, though explaining this convincingly is a major challenge!
>From then on there is a need to interpret as objectively as possible any
further symptoms that you're presented with. Some of the responses to
your
question are not heat related, such as those that mention the surface
friction properties - this would be a 'mechanical' issue. In fact skin
reaction causes can be categorised as 'allergic', 'mechanical',
'infection', 'disease', 'hydration/dehydration', 'radiation', 'chemical'
or
any combination of these. Then there are sensitivity issues unique to
each
user, these being 'environmental', 'individual' and 'pathological
(permanent/temporary)'. The purpose of defining causation like this is
that
firstly it removes the unique 'prosthetic language' that we all speak
and
confuse each other with, and secondly it allows us to really home in on
the
actual cause. In most cases, the result is not due to the product, but
the
'application' of the product.

Finally, I also would like to be added to your distribution list of the
article you mention.

Many thanks again, for the interesting debate.
____________________________

Richard R Hirons
Prosthetist
Össur Technical Services
Phone: +800 3539 3668
Facsimile: +800 3539 3299
Mobile: +44 (0) 7770 592 530
E-mail: <Email Address Redacted>
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I have seldom had heat problems with Alpha liners and we live in a very
hot
part of the world. Is your client applying anything the skin or liner
before
donning? The liners do get soft and more flexible when heated to body
temperature, I believe that that is the secret of the Alpha liners. Has
your
client used the liner for an extended period of time? We have a
competitive
cyclist and a soccer player who cannot wear their Alpha liner during
sport,
they use silicone liners but use the Alpha liners after sport. They find
that the sweat causes the liner to slip off because of the mineral oils.

Thanks for the article it is very interesting and something to think
about.
Another reason for itching in early activity is the capillaries close to
the
surface of the skin swell with extra blood used to cool the body, this
extra
activity cause redness and itching but goes away after two or three
runs/workouts.
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URTICARIA LIKE RASHES ARE MORE COMMON THAN WE ARE LEAD TO BELIEVE. IN
MY
EXPERIENCE IT DOES NOT APPLY TO ANY ONE PARTICULAR BRAND. IT HOWEVER IS
MORE
COMMON WITH LINERS THAT LEAVE SOME RESIDUE LIKE SO CALLED MINERAL OIL
RELEASE
 THAT IS ASSOCIATED WITH CERTAIN BRAND. INCIDENTALLY THERE DOES NOT
SEEM TO
BE ANY CURATIVE OR PROPHALACTIC VALUE IN THE OIL. VITAMIN E AND A &D
ARE A
DIFFERENT MATTER. URTICARIA HAPPENS TO ACTIVE AND INACTIVE PEOPLE
ALIKE.
SOME PEOPLE CAN GET SENSITIZED AND CANNOT EVEN LAY THE MATERIAL ON
THEIR
SKIN OTHERS WOULD WITH SOME SCRUPULUS CLEANING WILL DO FINE, THAT IS
SOME
PEOPLE MAY BE SENSITIVE TO THEIR OWN SWEAT/URIC ACID IN THEIR SWEAT.
THAT
DOES NOT MEAN THAT THERE ARE NO HYPER NON ALLERGENIC MATERIALS OUT
THERE.
WHEN I HAVE THE PRODUCT READY TO MARKET YOU MAY GET TO HEAR ABOUT.
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I would like a copy of the column. I have on occasion found these same
results with silicone liners.