Suspension Liners and Skin Rashes, Summary 1
Custom Prosthetic Services Ltd.
Description
Collection
Title:
Suspension Liners and Skin Rashes, Summary 1
Creator:
Custom Prosthetic Services Ltd.
Date:
5/16/2001
Text:
Thank you to all who responded with your comments and requests for
additional information.
Here is the Original Post:
> I have had a few amputee clients reporting red welts and a hive like rashes after using suspension liners and associated gel sheaths in their trans tibial prostheses. The Liner materials differed for each client,
> and skin tests were negative for yeast and allergic reactions. Mechanical irritants such as fiberglass particles were not evident. The one common element reported by the clients was that the liners felt
> 'hot'.
>
> Scrupulous hygiene and avoidance of the liners helped to resolve the skin rashes. Some clients found that they were able to resume use of the liners after a period of time.
>
> By chance I happened upon an article by a medical columnist/physician answering a question posed by a person inquiring about exercise induced rashes. To be brief, the physician suggested that the condition may be cholinergic urticaria. The rise in body temperature caused by exercise leads to the release of the neurotransmitter acetycholine, which precipitates the release of histamine, which produces an itchy rash of
> red dots. Typically the rash goes away within 30 minutes to 4 hours after a person stops exercising.
>
> The physician suggested drinking cold water to cool the body, exercising in an air-conditioned environment, and the use of specific antihistamines to address this condition. He also stated that many people with cholinergic urticaria are freed from its grip in a few years.
>
> I am wondering if anyone else has noticed similar heat related rashes occurring with their clients who use suspension liners, or have any further knowledge about this cholinergic urticaria condition? Please
> email me if you would like a copy of the medical column. I would be happy to collect and post your replies.
>
> Geoffrey Hall, B.Sc., C.P.( c )
----------------------------------------------------------------------------------------------------
SUMMARY OF RESPONSES TO SUSPENSION LINERS AND SKIN RASHES:
----------------------------------------------------------------------------------------------------
per The Merck Manual 16th Ed. 1992:
Uticaria = Hives; local wheals and erythema in the dermis. Usually are
essentially anaphylaxis limited to the skin and subcutaneuous tissues
and can be due to drug allery, insect stings or bites, desensitization
injections, or ingestion of certain foods (particularly eggs, shellfish,
nuts, or fruits).
Cholinergic = parasympathetic; (A descriptor) as in nerves, as in
Acetylcholine: the major neurotransmitter of the motorneurons autonomic
preganglion fibers, post ganglionic cholinergic fibers, and many neurons
in
the CNS.
Treatment is as your clients have learned: remove the source of
irritant. It is usually a self-limiting condition that generally
subsides in 1 to 7 days. If the cause/irritant is not obvious than
relief may be found through oral antihistamines. Topical
glucocorticoids are of no value.
Hope this helps.
-----------------------------------------------------------------------------------------------------
This is a good observation and the recommendation from the physician was
good. We have in two cases (both diabetes and elderly patients) used
specific antihistamines to address this condition. The reason behind it
was just the same Cholinergic Urticaria although the patient profile
usually is young adults of both sexes. The treatment that is recommended
is use of antihistamine 30-60 minutes before the activity that
precipitates the lesions. The problem is mostly solved when the skin has
adapted to this new environment and that can take between two to six
weeks and usually don't come back except when the patient start to use a
new liner. New linercreates more friction...
I don't recommend any treatment with out consulting a physician or
specialist in dermatology. This should not be confused with other
dermological problem that do occur and need a different approach.
Best regards
----------------------------------------------------------------------------------------------------
I am a prosthetist practicing in South Africa. The area I live in
regularly has temperatures that reach into the 40 degrees in summer.
Most of my amputees are wearing the Alpha liner. It is very important
that the Alpha is therefore sold as a set. As long as the fit is correct
& airtight, your patient should not suffer any abnormal discomfort. Yes,
they do get hot, but not intolerably so. As long as the patient washes
his liner well on a daily basis & alternates it, he should be fine. The
trouble starts when the liner developes an air leak as that is when they
start sweating badly. To summarise, as long as the personal hygiene is
good, your aptient should not suffer excessively. Good luck.
----------------------------------------------------------------------------------------------------
You do not mention which liners you have been using. I have had these
problems when using Iceross and Alps silicone liners, I changed to Alpha
and 90 % of these problems went away. My thought process was that the
silicone skin interface is too strong and that this causes friction
which the skin cannot deal with and results in these red spots and
welts. The new Alps soft silicone has also resolved these problems.
Another though that I have had is that the patient's sweat is too acid
for their skin and cause a rash similar to a baby's rash and we used
baby products to treat these problems with success. Hope this helps
-----------------------------------------------------------------------------------------------------
I had a pt with a similar sounding heat rash w3ith blistering and
welts. He was not active but still developed this rash. He ended up
using a thin cool max sock between his skin and the liner.
He had a lot of scarring and was very sensitive to pressure of any kind
and could not bear weight. Two years later he had a neglected stitch
removed and appropriate pain meds and now he is wearing the liner and
walking without the heat rash problem.I would be interested in receiving
that article. Thanks
------------------------------------------------------------------------------------------------------
I do not know if the following info will directly relate to your
question about the dx Cholinergic Urticaria but I have had a few
patients in the past who had trouble similar to what you described and
one solution that seemed to work well was to reduce the sweating
response artificially.Once the irritation was in remission from non-use
of the gel liner I would have the patient begin using a non-irritating
GEL ANTIPERSPIRANT such as MITCHUMS. Make sure it is a clear gel type
and that it is aniperspirant not just a deoderant. I know this sounds
strange but try it and see if it helps. This stuff usally works in our
axilla so why wouldn't it work elsewhere. One note of caution...... make
sure they discontinue use of the antiperspirant if ANY type of skin
irritation is present- just as it says in the directions. I will be
wondering if this helped so please let me know how it woked out. Good
luck!
--------------------------------------------------------------------------------------------------------
Try Columbia Medicated powder.
--------------------------------------------------------------------------------------------------------
I got a sample of this lotion from Cascade called ProstheCare Amputee
Liner Donning Lotion. Give them a call. I gave a sample to a few
patients and they really found it to be a good product.
--------------------------------------------------------------------------------------------------------
It's possible that it's tension being applied to the liner/sleeve when
the patient is donning. if after they roll the liner on they stretch
it for removing any wrinkles, they preload tension to the proximal edge.
if that patient now sits for an extended period the flexed knee is going
to create more tension causing the skin tissue to tear. i will recommend
to my patients that if they do apply the liner in that fashion, to lift
the liner out and allow it back down onto the thigh in a relaxed manner.
-----------------------------------------------------------------------------------------------------
Have you tried the antiperspirant that alps has on the market?
-----------------------------------------------------------------------------------------------------
Please send me the article that you mentioned in your email to the list
serv. I have a patient that wears
neoprene suspension sleeves for years and sudddenly developed similar
rash and welts like what you
mentioned. He also keeps his leg and the sleeve very clean. I will
look forward to hearing from you.
------------------------------------------------------------------------------------------------------
I would appreciate a copy of the medical column, and look forward to
seeing what feedback you receive. This condition may explain some
allergy-like reactions described by various colleagues.
------------------------------------------------------------------------------------------------------
additional information.
Here is the Original Post:
> I have had a few amputee clients reporting red welts and a hive like rashes after using suspension liners and associated gel sheaths in their trans tibial prostheses. The Liner materials differed for each client,
> and skin tests were negative for yeast and allergic reactions. Mechanical irritants such as fiberglass particles were not evident. The one common element reported by the clients was that the liners felt
> 'hot'.
>
> Scrupulous hygiene and avoidance of the liners helped to resolve the skin rashes. Some clients found that they were able to resume use of the liners after a period of time.
>
> By chance I happened upon an article by a medical columnist/physician answering a question posed by a person inquiring about exercise induced rashes. To be brief, the physician suggested that the condition may be cholinergic urticaria. The rise in body temperature caused by exercise leads to the release of the neurotransmitter acetycholine, which precipitates the release of histamine, which produces an itchy rash of
> red dots. Typically the rash goes away within 30 minutes to 4 hours after a person stops exercising.
>
> The physician suggested drinking cold water to cool the body, exercising in an air-conditioned environment, and the use of specific antihistamines to address this condition. He also stated that many people with cholinergic urticaria are freed from its grip in a few years.
>
> I am wondering if anyone else has noticed similar heat related rashes occurring with their clients who use suspension liners, or have any further knowledge about this cholinergic urticaria condition? Please
> email me if you would like a copy of the medical column. I would be happy to collect and post your replies.
>
> Geoffrey Hall, B.Sc., C.P.( c )
----------------------------------------------------------------------------------------------------
SUMMARY OF RESPONSES TO SUSPENSION LINERS AND SKIN RASHES:
----------------------------------------------------------------------------------------------------
per The Merck Manual 16th Ed. 1992:
Uticaria = Hives; local wheals and erythema in the dermis. Usually are
essentially anaphylaxis limited to the skin and subcutaneuous tissues
and can be due to drug allery, insect stings or bites, desensitization
injections, or ingestion of certain foods (particularly eggs, shellfish,
nuts, or fruits).
Cholinergic = parasympathetic; (A descriptor) as in nerves, as in
Acetylcholine: the major neurotransmitter of the motorneurons autonomic
preganglion fibers, post ganglionic cholinergic fibers, and many neurons
in
the CNS.
Treatment is as your clients have learned: remove the source of
irritant. It is usually a self-limiting condition that generally
subsides in 1 to 7 days. If the cause/irritant is not obvious than
relief may be found through oral antihistamines. Topical
glucocorticoids are of no value.
Hope this helps.
-----------------------------------------------------------------------------------------------------
This is a good observation and the recommendation from the physician was
good. We have in two cases (both diabetes and elderly patients) used
specific antihistamines to address this condition. The reason behind it
was just the same Cholinergic Urticaria although the patient profile
usually is young adults of both sexes. The treatment that is recommended
is use of antihistamine 30-60 minutes before the activity that
precipitates the lesions. The problem is mostly solved when the skin has
adapted to this new environment and that can take between two to six
weeks and usually don't come back except when the patient start to use a
new liner. New linercreates more friction...
I don't recommend any treatment with out consulting a physician or
specialist in dermatology. This should not be confused with other
dermological problem that do occur and need a different approach.
Best regards
----------------------------------------------------------------------------------------------------
I am a prosthetist practicing in South Africa. The area I live in
regularly has temperatures that reach into the 40 degrees in summer.
Most of my amputees are wearing the Alpha liner. It is very important
that the Alpha is therefore sold as a set. As long as the fit is correct
& airtight, your patient should not suffer any abnormal discomfort. Yes,
they do get hot, but not intolerably so. As long as the patient washes
his liner well on a daily basis & alternates it, he should be fine. The
trouble starts when the liner developes an air leak as that is when they
start sweating badly. To summarise, as long as the personal hygiene is
good, your aptient should not suffer excessively. Good luck.
----------------------------------------------------------------------------------------------------
You do not mention which liners you have been using. I have had these
problems when using Iceross and Alps silicone liners, I changed to Alpha
and 90 % of these problems went away. My thought process was that the
silicone skin interface is too strong and that this causes friction
which the skin cannot deal with and results in these red spots and
welts. The new Alps soft silicone has also resolved these problems.
Another though that I have had is that the patient's sweat is too acid
for their skin and cause a rash similar to a baby's rash and we used
baby products to treat these problems with success. Hope this helps
-----------------------------------------------------------------------------------------------------
I had a pt with a similar sounding heat rash w3ith blistering and
welts. He was not active but still developed this rash. He ended up
using a thin cool max sock between his skin and the liner.
He had a lot of scarring and was very sensitive to pressure of any kind
and could not bear weight. Two years later he had a neglected stitch
removed and appropriate pain meds and now he is wearing the liner and
walking without the heat rash problem.I would be interested in receiving
that article. Thanks
------------------------------------------------------------------------------------------------------
I do not know if the following info will directly relate to your
question about the dx Cholinergic Urticaria but I have had a few
patients in the past who had trouble similar to what you described and
one solution that seemed to work well was to reduce the sweating
response artificially.Once the irritation was in remission from non-use
of the gel liner I would have the patient begin using a non-irritating
GEL ANTIPERSPIRANT such as MITCHUMS. Make sure it is a clear gel type
and that it is aniperspirant not just a deoderant. I know this sounds
strange but try it and see if it helps. This stuff usally works in our
axilla so why wouldn't it work elsewhere. One note of caution...... make
sure they discontinue use of the antiperspirant if ANY type of skin
irritation is present- just as it says in the directions. I will be
wondering if this helped so please let me know how it woked out. Good
luck!
--------------------------------------------------------------------------------------------------------
Try Columbia Medicated powder.
--------------------------------------------------------------------------------------------------------
I got a sample of this lotion from Cascade called ProstheCare Amputee
Liner Donning Lotion. Give them a call. I gave a sample to a few
patients and they really found it to be a good product.
--------------------------------------------------------------------------------------------------------
It's possible that it's tension being applied to the liner/sleeve when
the patient is donning. if after they roll the liner on they stretch
it for removing any wrinkles, they preload tension to the proximal edge.
if that patient now sits for an extended period the flexed knee is going
to create more tension causing the skin tissue to tear. i will recommend
to my patients that if they do apply the liner in that fashion, to lift
the liner out and allow it back down onto the thigh in a relaxed manner.
-----------------------------------------------------------------------------------------------------
Have you tried the antiperspirant that alps has on the market?
-----------------------------------------------------------------------------------------------------
Please send me the article that you mentioned in your email to the list
serv. I have a patient that wears
neoprene suspension sleeves for years and sudddenly developed similar
rash and welts like what you
mentioned. He also keeps his leg and the sleeve very clean. I will
look forward to hearing from you.
------------------------------------------------------------------------------------------------------
I would appreciate a copy of the medical column, and look forward to
seeing what feedback you receive. This condition may explain some
allergy-like reactions described by various colleagues.
------------------------------------------------------------------------------------------------------
Citation
Custom Prosthetic Services Ltd., “Suspension Liners and Skin Rashes, Summary 1,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/216629.
