Case Study: Localized Papular Eruption Following ECG Electrode Application
Case at a Glance
A 17-year-old female undergoing ambulatory cardiac monitoring with a Holter device developed a localized skin reaction characterized by erythematous papules directly beneath the adhesive ECG electrodes.
Patient's Story
A 17-year-old female presented for evaluation of a skin condition that developed while she was wearing a Holter monitor for a cardiac workup. The patient reported that she had been wearing the monitor for several days and had changed the adhesive ECG stickers approximately four times. She then noticed the appearance of small, raised bumps on her chest, confined to the areas where the stickers had been applied. While the lesions were not painful or pruritic, their appearance caused her significant cosmetic concern.
Initial Assessment
On self-examination, the patient observed multiple small, discrete, erythematous papules clustered on her chest. A photograph provided for review confirmed a well-demarcated area of skin inflammation corresponding precisely to the location of an ECG electrode pad. The surrounding skin appeared normal. The clinical picture was highly suggestive of a cutaneous reaction to an external agent.
The Diagnostic Journey
The patient's history was pivotal in forming a diagnosis. The eruption's onset was directly correlated with the application of the ECG electrodes, and its distribution was limited to the area of contact with the device's adhesive. This presentation strongly pointed towards a contact dermatitis. The differential diagnosis included allergic contact dermatitis (a delayed-type hypersensitivity reaction to a component in the adhesive, such as acrylates or colophony) and irritant contact dermatitis (a non-immunologic reaction from prolonged skin occlusion and chemical irritation). Given the papular nature of the rash, an allergic etiology was considered most likely.
Final Diagnosis
Allergic Contact Dermatitis to ECG Electrode Adhesive.
Treatment Plan
The patient, concerned about the rash, independently removed the Holter monitor and the associated electrodes before the prescribed monitoring period was complete. The primary and most effective treatment for contact dermatitis is the immediate removal of the offending agent. Standard subsequent management would involve gently cleansing the affected skin and, if symptoms like itching or inflammation persist, applying a low-to-mid potency topical corticosteroid. The patient was advised to inform her cardiologist about the reaction and the incomplete study.
Outcome and Follow-up
By removing the adhesive electrodes, the patient initiated the correct course of action for resolving the dermatitis. The skin lesions were expected to resolve completely within one to two weeks. It is crucial for this adverse reaction to be documented in the patient's medical record to prevent future exposure. For any subsequent need for ECG monitoring or other procedures requiring medical adhesives, the use of hypoallergenic alternatives is strongly recommended. The patient will need to follow up with her cardiologist to discuss the results of the partial Holter study and determine if further cardiac evaluation is necessary.