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Pharmacy and Medications

Does Duraprep Contain Enough Iodine to Affect a Person with Iodine Allergy?

04/17/2008

Question:

I have an iodine allergy which has been documented. When I recently had surgery to remove hardware from feet, I mentioned that I could not tolerate Detadine. They prepped my feet with Duraprep. After itching several days afterward, which I blamed on the dry heat in my house, I found out that there is iodine in Duraprep. The doctor states that there is not enough iodine in this prepping solution to have caused this reaction. I say that`s like being a `little bit pregnant.` I feel the doctor and or staff goofed big time. Could I have your response.

Answer:

Duraprep® is a disinfectant surgical skin preparation that contains iodine povacrylex [0.7% available Iodine] and isopropyl alcohol, 74% w/w that is applied to the skin around the site of a surgical incision. The alcohol evaporates leaving a water resistant film on the skin surface. Upon application it kills many skin bacteria and the residual film provides a persistent barrier to bacterial growth and contamination thus reducing the likelihood of surgical wound infection. Duraprep® contains slightly less available iodine than Betadine solution 10%.

The labeling for Duraprep® advises against using the product in patients with known allergy to iodine. The material safety data sheet for Duraprep® states that skin contact may cause mild irritation with associated redness swelling and itching. Allergic skin reactions may produce similar symptoms - redness, swelling, itching and blisters. Itching or pruritis can occur for a number of reasons including dry air during winter and as part of the normal healing process.

Several surgical skin prep products are available for reducing bacterial on the skin prior to and during surgery. Not all of them contain iodine. A recent study by Ostrander et al in The Journal of Bone and Joint Surgery compared Duraprep® to two other products that do not contain iodine in patients requiring foot surgery. In the study, a product containing chlorhexidine (ChloraPrep® - 2% chlorhexidine gluconate and 70% isopropyl alcohol) was most effective in reducing bacterial load. However, although not statistically significant, one patient in the Chloraprep® group developed an infection while no patients pretreated with Duraprep® did.

Surgical manipulation of the foot and ankle is particularly prone to Infections. These Infections have the potential to turn a relatively routine procedure in to an intervention with devastating consequences that could include amputation, permanent disability or worse. Thoroughly disinfecting the skin adjacent to the surgical incision and meticulous technique are important factors limiting this risk.

It's not clear whether your itching is related to use of the Duraprep® or something else as you have implied. The most important thing here is whether your foot is healing correctly and is infection-free. Some itching during the healing process seems a minimal concern that is likely to be easily treated.

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Response by:

Robert James Goetz, PharmD, DABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati