Replies to Plagio skin irritation
Clinical Orthotic Consultants
Description
Collection
Title:
Replies to Plagio skin irritation
Creator:
Clinical Orthotic Consultants
Date:
12/4/2009
Text:
Below is the original post..
I have fit over 70 plagio helmets in the last 5 years.so not an expert, but
experienced enough. I line my helmets with Thermofoam (aliplast). I have
never had a skin irritation like I am having with this little girl. Over
her right eye, she has about a 1x2 area (this is a pressure area for her)
of irritated skin.I wouldn't consider this to be too much pressure causing
this, more like a rash. She does not get this over her posterior bossing
where I would expect equal pressure applied.
We are still in the early days of fitting, and the most she has worn the
helmet is 6 hours.she does not complain of pain, or seem irritable, but I am
concerned with this area.looks like a big patch of eczema really, although
she has no history of this condition. Mom is washing her and the helmet
with baby shampoo, making sure to rinse very well each time.
Has anyone run into this? Any solutions? As I said, I have never seen a
reaction to the helmet like this, and I have used the same procedures in
fabrication and wear in process each time.
Here are the responses.
I have usually sent this type of patient to their pediatrician. I have also
recommended Hydrocortisone cream, I was told the over the counter strength
is safe to use on babies by a pediatrician. I have also put a piece of
shearban over the area of irritation. This seems to help sometimes
Derek, I ran into a similar problem and I added 1/16 stickyback velfoam
over the aliplast. Created a breathable soft interface. Got the 6velfoam
roll from alimed, but pell may have it as well.
If it seems to be a friction issue shear ban has worked well for me in the
past. Also not an expert but have fit several
replace aliplast liner with plastazote
You might try a non perfumed baby powder for that area, if this does not
work try a small patch of mole skin. When you put the helmet on spread it
out more.
I'm a student in the P&O program at Georgia Tech and just saw a patient with
a practitioner the other day who also had a rash from the helmet she was
wearing. He recommended using Dr. Bonner's Tea Tree Oil soap on the helmet.
I hope this helps!
back in time i had my own design and fitted 6 to 12 of those a week.
what you describe sounds like edge pressure due to either rotation or
sliding component. where it is, it sounds like when she sleeps, helmet
slides forward and stops over the eyebrow. bone in that area is slightly
convex, so it creates a natural barrier. or it wants to rotate in that
direction.
i am not sure how your helmets suspend. mine did from suboccipital undercuts
and along zygomatic bones. but mine where very deep, almost like football
helmets, with significant cranial encapsulation.
aliplast can be very rough on the edge. i'd say, bevel the edge in that area
so that it flares away from the skin/bone at about 30 degrees angle. then
patch it with sheerban. or thin plastazote layer, as plastazote is much
smoother than aliplast.
i do not blame this on hygiene. it's local spot, if it's dirty - it's dirty
everywhere, or around cheek bones, as they feed kids with liquid foods and
pure, and all that gets into the liner one way of the other.
you need to re-evaluate suspension and make sure that rotational component
is reduced to nothing.
far as i remember, helmets always had tendency to migrate in one direction.
that's why i had my trim so far and flat down on zygomatics, as it was
giving me nice, flat de-rotational areas. side to side - zygomatics, forward
- suboccipital.
we always told our parents to clean helmets inside with rubbing alcohol, 2-3
times a day. good cleaner - and it's gone, evaporates. soaps build up in
liners no matter what.
Stop having the mother wash the helmet with baby shampoo. All soaps are bad
with the use of helmets regardless of how clean they try and rinse them.
Have them clean with rubbing alcohol. You can also recommend dusting the
helmet regularly with cornstarch based baby powder, do not use talc. If
this doesn't resolve the issue, I recommend lining the helmet with moleskin,
it takes a lot of time, but always works. I know of other practitioners
that use helmet socks, but I think they are a bother and not worth it. I
hope this helps.
I recommend rubbing alcohol ONLY. All of these soaps and shampoos have
fragrance and detergents. Both are leading causes of eczema outbreaks.
Just a thought - the last case where a child had bad skin rash was cleared
up with 2x Head and Shoulders. Worth a try?
I wanted to share a technical paper that might be helpful to you. It was
submitted to us just last week by Phil Stevens, CPO Director of Orthotics
and Clinical Education at Hanger Orthopedic in Salt Lake City, Utah. I hope
it helps. You can find it on our website at:
<URL Redacted>
vens-12.09.pdf
Please feel free to contact me if you have any questions about ShearBan.
Following fitting of over #500 consider the following as possible
suggestions: a) follow the shampooing and rinse with an isopropyl alcohol
wash to thoroughly disinfect and then re-rinse and dry the helmet completely
(Any shampoo residue must be removed, if not thoroughly rinsed you will get
a skin reaction.) b) reduce pressures for short term to build FT wear c)
consider trying Becker Shear Ban to reduce shear and. this is difficult to
apply smoothly on the concave interior and a last resort. I have used this
only on side burn extensions for one child. She developed a sinus/tear
duct infection with lots of weeping drainage and resultant unresolvable skin
rashes until I placed the Shear Ban. My suspicion though is hygiene related
to poor rinsing of shampoo from head and/or helmet. We recommend shampooing
helmet interior no more than twice weekly, otherwise wipe out helmet with
alcohol and soft cloth daily. Some parents also cheat and use the
Oh-so-convenient baby wipes with the same problem you describe.
have run into this problem on occasion. Mostly with fair skinned kids (red
heads seem to be more reactive to skin pressures). If you have minimized
pressure (using lipstick to confirm pressure is where you think it is) than
you may try over the counter hydrocortisone cream over the affected area to
see if it decreases the symptoms.
Derek Kozar M.Sc., C.O.(c)
Certified Orthotist
Clinical Orthotic Consultants of Windsor, Inc.
316-3200 Deziel Dr.
Windsor, ON
N8W 5K8
519-944-8340 p
519-944-8360 f
519-982-1747 c
www.cocwindsor.com
I have fit over 70 plagio helmets in the last 5 years.so not an expert, but
experienced enough. I line my helmets with Thermofoam (aliplast). I have
never had a skin irritation like I am having with this little girl. Over
her right eye, she has about a 1x2 area (this is a pressure area for her)
of irritated skin.I wouldn't consider this to be too much pressure causing
this, more like a rash. She does not get this over her posterior bossing
where I would expect equal pressure applied.
We are still in the early days of fitting, and the most she has worn the
helmet is 6 hours.she does not complain of pain, or seem irritable, but I am
concerned with this area.looks like a big patch of eczema really, although
she has no history of this condition. Mom is washing her and the helmet
with baby shampoo, making sure to rinse very well each time.
Has anyone run into this? Any solutions? As I said, I have never seen a
reaction to the helmet like this, and I have used the same procedures in
fabrication and wear in process each time.
Here are the responses.
I have usually sent this type of patient to their pediatrician. I have also
recommended Hydrocortisone cream, I was told the over the counter strength
is safe to use on babies by a pediatrician. I have also put a piece of
shearban over the area of irritation. This seems to help sometimes
Derek, I ran into a similar problem and I added 1/16 stickyback velfoam
over the aliplast. Created a breathable soft interface. Got the 6velfoam
roll from alimed, but pell may have it as well.
If it seems to be a friction issue shear ban has worked well for me in the
past. Also not an expert but have fit several
replace aliplast liner with plastazote
You might try a non perfumed baby powder for that area, if this does not
work try a small patch of mole skin. When you put the helmet on spread it
out more.
I'm a student in the P&O program at Georgia Tech and just saw a patient with
a practitioner the other day who also had a rash from the helmet she was
wearing. He recommended using Dr. Bonner's Tea Tree Oil soap on the helmet.
I hope this helps!
back in time i had my own design and fitted 6 to 12 of those a week.
what you describe sounds like edge pressure due to either rotation or
sliding component. where it is, it sounds like when she sleeps, helmet
slides forward and stops over the eyebrow. bone in that area is slightly
convex, so it creates a natural barrier. or it wants to rotate in that
direction.
i am not sure how your helmets suspend. mine did from suboccipital undercuts
and along zygomatic bones. but mine where very deep, almost like football
helmets, with significant cranial encapsulation.
aliplast can be very rough on the edge. i'd say, bevel the edge in that area
so that it flares away from the skin/bone at about 30 degrees angle. then
patch it with sheerban. or thin plastazote layer, as plastazote is much
smoother than aliplast.
i do not blame this on hygiene. it's local spot, if it's dirty - it's dirty
everywhere, or around cheek bones, as they feed kids with liquid foods and
pure, and all that gets into the liner one way of the other.
you need to re-evaluate suspension and make sure that rotational component
is reduced to nothing.
far as i remember, helmets always had tendency to migrate in one direction.
that's why i had my trim so far and flat down on zygomatics, as it was
giving me nice, flat de-rotational areas. side to side - zygomatics, forward
- suboccipital.
we always told our parents to clean helmets inside with rubbing alcohol, 2-3
times a day. good cleaner - and it's gone, evaporates. soaps build up in
liners no matter what.
Stop having the mother wash the helmet with baby shampoo. All soaps are bad
with the use of helmets regardless of how clean they try and rinse them.
Have them clean with rubbing alcohol. You can also recommend dusting the
helmet regularly with cornstarch based baby powder, do not use talc. If
this doesn't resolve the issue, I recommend lining the helmet with moleskin,
it takes a lot of time, but always works. I know of other practitioners
that use helmet socks, but I think they are a bother and not worth it. I
hope this helps.
I recommend rubbing alcohol ONLY. All of these soaps and shampoos have
fragrance and detergents. Both are leading causes of eczema outbreaks.
Just a thought - the last case where a child had bad skin rash was cleared
up with 2x Head and Shoulders. Worth a try?
I wanted to share a technical paper that might be helpful to you. It was
submitted to us just last week by Phil Stevens, CPO Director of Orthotics
and Clinical Education at Hanger Orthopedic in Salt Lake City, Utah. I hope
it helps. You can find it on our website at:
<URL Redacted>
vens-12.09.pdf
Please feel free to contact me if you have any questions about ShearBan.
Following fitting of over #500 consider the following as possible
suggestions: a) follow the shampooing and rinse with an isopropyl alcohol
wash to thoroughly disinfect and then re-rinse and dry the helmet completely
(Any shampoo residue must be removed, if not thoroughly rinsed you will get
a skin reaction.) b) reduce pressures for short term to build FT wear c)
consider trying Becker Shear Ban to reduce shear and. this is difficult to
apply smoothly on the concave interior and a last resort. I have used this
only on side burn extensions for one child. She developed a sinus/tear
duct infection with lots of weeping drainage and resultant unresolvable skin
rashes until I placed the Shear Ban. My suspicion though is hygiene related
to poor rinsing of shampoo from head and/or helmet. We recommend shampooing
helmet interior no more than twice weekly, otherwise wipe out helmet with
alcohol and soft cloth daily. Some parents also cheat and use the
Oh-so-convenient baby wipes with the same problem you describe.
have run into this problem on occasion. Mostly with fair skinned kids (red
heads seem to be more reactive to skin pressures). If you have minimized
pressure (using lipstick to confirm pressure is where you think it is) than
you may try over the counter hydrocortisone cream over the affected area to
see if it decreases the symptoms.
Derek Kozar M.Sc., C.O.(c)
Certified Orthotist
Clinical Orthotic Consultants of Windsor, Inc.
316-3200 Deziel Dr.
Windsor, ON
N8W 5K8
519-944-8340 p
519-944-8360 f
519-982-1747 c
www.cocwindsor.com
Citation
Clinical Orthotic Consultants, “Replies to Plagio skin irritation,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/231025.
