501 From the Contact Dermatitis Investigation Unit, University of Manchester Section of Dermatology,Hope Hospital,Salford a ;the Disablement Services Centre,Withington Hospital,Manchester b ; and the Department of Occupational and Environmental Dermatology,Universitetssjukhuset,Malmö. c Reprint requests:Michael H.Beck,Contact Dermatitis Investigation Unit, University of Manchester Section of Dermatology, Hope Hospital,Stott,Lane,Salford,M6 8HD,UK. Copyright © 2000 by the American Academy of Dermatology,Inc. 0190-9622/2000/$12.00 + 0 16/1/102643 I n the early part of this century artificial limbs were of metal, wood, and leather construction. New materials and technologies have allowed considerable advances in recent years. All the patients in our study use a modular prosthesis. The essential modular components of these are a ther- moplastic socket, a liner of expanded plastic, stump sleeves of either cotton or silicon/mineral oil con- struction, suspension element, and the main body of the replacement limb (Fig 1). The suspension ele- ment is either a fabric and butyl rubber sheath or a fabric belt and fastener. In some patients the residual limb is held securely in the socket by suction, the socket being sealed by a rubber valve once the limb is in place. The major part of the prosthesis is a metal frame with articulations to replace the endoskeletal elements and an outer casing consisting of an acrylic- based resin material. Within the modular limb and socket, acrylic materials may be used as thread sealants on metal bolts. Neoprene-based impact adhesives containing para -tertiary butyl phenol may be used to apply kid-leather linings to sockets. Epoxy and polyester materials were not used in prostheses produced at the Manchester Disablement Services Center. The normal use of a prosthesis requires good skin integrity on the residual limb. However, despite the advances in design and construction of artificial limbs, the skin of an amputated limb shaft is not adapted to the heat, humidity, friction, and pressure encountered within a limb prosthesis. Consequently some skin problems are inevitable. Furthermore, occlusion and humidity might be expected to increase the likelihood of contact sensitivities to the constituents of moisturizing creams, medicaments, and the prosthesis itself. We have investigated the spectrum of dermatoses affecting a population of amputees, with particular emphasis on contact dermatitis. Clinical features suggesting allergic contact dermatitis (ACD) have been sought. METHODS The population under study comprised all patients attending the subregional Disablement Services Centre during a 2 week period. The center serves a list of approximately 3000 amputees; during CLINICAL REVIEW Skin disorders in amputees Calum C. Lyon, MA, MRCP, a Jai Kulkarni, FRCP, b Erik Zimerson, c Ernest Van Ross, FRCS, b and Michael H. Beck, FRCP a Salford and Manchester, United Kingdom, and Malmö, Sweden Background: Dermatologic problems restrict the normal use of a prosthetic limb. The importance of contact dermatitis to skin morbidity in a population of amputees and the selection criteria for patch testing have not been clearly defined. Objective: We describe the range of dermatoses seen in a population of amputees and examine the incidence, causes, and patterns of contact dermatitis. Methods: This is a questionnaire-based, cross-sectional study of 210 amputees. Those with a skin problem were assessed by a dermatologist. Patch testing was undertaken in patients with persistent dermatitis. Re su lts: A total of 34% of amputees experienced a skin problem. Lesions resulting from friction, pressure, and occlusion are common. Allergic contact dermatitis is seen in a third of patients with stump dermatitis. There are no features that distinguish allergic from irritant (chemical or physical) dermatitis. Conclusion: Dermatologic problems are common in prosthetic limb users. Allergic contact dermatitis is a significant problem, and all patients with dermatitis on the residual limb should be patch tested. (J Am Acad Dermatol 2000;42:501-7.)