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- Prof. Nelson Lee Novick, M.D.
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- Daniella Gork, Esthetician
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- Daniel Novick, Office Manager, USA
- Yoni Novick, Medical Practice Group Manager
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- Nelson Lee Novick, M.D.
- 500 East 85th Street
- Suite P-1
- New York, New York 10028
- Tel: 212-772-9300
- Fax: 212-772-0524
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- קוסמדיספא
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Contact Dermatitis
Steering Clear of Contact Allergies
by Nelson Lee Novick, MD, FACP
Allergic contact dermatitis, or inflammation of the skin due to contact with some offending ingredient, prompts nearly six million doctor visits each year. However, most people are unaware that contact dermatitis is actually two distinct kinds of diseases.
One type of contact dermatitis, known as allergic contact dermatitis, like any true allergic condition, such as hay fever, is actually due to exposure to a substance that provokes an exaggerated response by the immune system. Much more commonly, however, we see direct, instantaneous irritation as a result of contact with harsh solvents, cleansers, etc., a condition known as irritant contact dermatitis, which does not involve the immune system. A common example would be the development of raw, red, chapped, and cracked hands following repeated toilet soap and water hand washing. Of all patients with contact dermatitis, approximately 70 percent suffer from this variety.
True allergic contact dermatitis constitutes only 30 percent of all cases. Although women appear to suffer allergic contact dermatitis more than men, this is quite likely due to the fact that women are exposed through cosmetics to a much larger array of potentially allergenic ingredients.
Contact dermatitis can have a variety of manifestations. In mild cases, there may only be redness and itching localized to the site of contact. In more severe cases, you may see blisters, oozing, weeping, scaling, crusts and scabs. Pussy areas may develop when, to complicate matters still further, breaks in the skin’s barrier have led to a bacterial superinfection.
If left untreated allergic contact dermatitis occasionally disseminates throughout the skin. This is not because the condition is contagious and has spread the way a bacterial infection, for example, might from one area to another. Instead, the body’s immune system can get so hyperstimulated that it begins to reproduce the lesions over areas that had not received any direct contact with the allergen whatsoever. It usually takes about ten days to two weeks for such a reaction to develop. This kind of dissemination over large areas of skin, is certainly not uncommon with poison ivy dermatitis, (arguably the most well-known of all forms of contact dermatitis), and it is one especially good reason for promptly treating poison ivy rash while it is still localized to the area of contact.
Investigators have identified over 3000 contact-allergy provoking chemicals in our everyday environment, and the list continues to grow with technological advances. Besides poison ivy (and its relatives poison oak and poison sumac), one of the most common allergenic substances is nickel, with approximately 10 percent of women allergic to it. But this is hardly surprising, given the high exposure of women to nickle in jewelry, and not only in inexpensive costume jewelry. Even 14 K gold contains a substantial enough quantity of nickle (to which the gold is alloyed to impart strength) that can be leached out by perspiration to trigger allergy.
Fragrances and preservatives found in many different kinds of cosmetic and toiletry products weigh in next as potential offenders. But avoiding fragrances can be a very tricky problem, since even products labeled as unscented may contain them. To mask the natural industrial smell of some products, manufacturers often add fragrances. So, the resulting product, labeled unscented, can be a big problem for unsuspecting fragrance-allergic individuals. Other common allergens include rubber and hair dyes.
The most important step in treating anyone with a contact allergy is to identify what the culprit allergen(s) is so that further contact with it can be avoided or at least minimized. For this a Sherlockian detective approach must be taken by both patient and doctor. Although allergies can develop to products that have been used without problem for years, they are more likely due to something that has recently been introduced. Noting, for example, that a particular rash over the trunk and extremities followed a switch to a new detergent or fabric softener a few days or even a few weeks earlier points strongly to one or the other of those products as the possible culprit.
In a similar fashion, the location of the rash can provide the necessary clue to the cause. For example, an itchy rash on the earlobe is very likely an earring-related nickel allergy. Rashes on the skin of the eyelids may be due to airborne substances like fragrances or volatile chemicals like epoxy resins in glues or may arise, from chemicals applied to the hands, which are then inadvertently touched to the thin skin of the eyelids..
When a contact allergy is strongly suspected, but neither the history nor the clinical features provide sufficient clues as to the precise cause, dermatologists often turn to patch testing. After years of research, scientists have been able to isolate the 24 allergens that are responsible for between 60 percent and 80 percent of all contact allergies. These have been incorporated into a series of patches that are applied to the patients back and left in place for 48 to 72 hours. When a reaction is found to one or more of the patch test materials, the doctor can then go back to check which of the products the patient uses contains them and suggest alternate products.
Of course, the obvious “cure” for contact dermatitis is avoidance of the culprit offending allergen. Once this is done, the eruption will usually disappear on its own within one to two weeks. Severe reactions may sometimes need the addition of topical antiinflammatory steroid creams or even oral corticosteroids.
Individuals prone to skin allergies are advised to take special precautions to prevent recurrences. All newly purchased clothes should be washed at least twice before first wearing in order to rinse out any residual formaldehyde resins or formaldehyde-releasing substances. Fragrance-free (not unscented) products should be used. Also look for hypoallergenic, gentle moisturizing shampoos cleansers, emollient creams and non-chemical sunscreens, ie. those containing the physical blocking agents zinc oxide or titanium dioxide. Creams generally make better choices than lotions since they typically possess lower concentrations of potentially irritating volatile substances.
With a little detective work and a careful reading of product labels before purchasing much of the sting can be taken out of contact dermatitis.
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