Repeat Exposure to Silver-Impregnated Dressing Does Not Increase Risk of Allergic Contact Dermatitis: A Prospective...

Certain dressings have been linked to allergic contact dermatitis (ACD), with subsequent exposure resulting in an eczematous skin reaction. The purpose of this study was to compare rates of ACD between patients undergoing arthroplasty who were previously exposed to and who were naive to a specific silver-impregnated dressing.

There were 396 patients who underwent 457 primary hip and knee arthroplasties and were prospectively enrolled between August 1, 2023, and December 31, 2024. Patients were classified as "naive" or "exposed" based on prior dressing exposure. Skin checks were performed on postoperative days seven and 14. The primary outcome was ACD. Multivariable logistic regression analyses were performed to evaluate if prior dressing exposure was an independent risk factor for the development of ACD. Based on documented ACD rates of 1 and 2% in "naïve" and "exposed" patients, respectively, power analysis (80% power, alpha = 0.05, and 1:1 allocation) required 314 patients total (157 per arm) to detect a two-fold difference in ACD rates. There were 177 procedures performed in "exposed" patients and 280 in "naive" patients. There were no significant differences in age, procedure type, sex, Charlson Comorbidity Index, smoking status, presence of diabetes, or presence of underlying skin conditions between cohorts. The mean body mass index was significantly higher in the "exposed" cohort (34.3 versus 30.6; P < 0.0001).

There was no difference in rates of ACD between "exposed" and "naive" patients (1.7 versus 1.8%, P = 1.00). Multivariable analyses showed that previous dressing exposure was not associated with increased risk of ACD (odds ratio: 1.16, 95% confidence interval: 0.30 to 4.44, P = 0.831).

Prior exposure to this silver-impregnated dressing was not associated with an increased risk of ACD. Subsequent application of these dressings may be applied with a similar risk profile to the first-time application.