Source: www.aafa.org, Asthma and Allergy Foundation of America (AAFA)
One night I woke up with a painful rash on most of my body. I put some cortisone cream on the rash to relieve the itching, but the rash was still there the next day. Finally, I talked to my allergist, who asked me a series of questions about what I’d touched in the last few days and any new products like soaps or cosmetics I’d used. When I checked my laundry soap, I noticed it was labeled “scented.” After I switched back to scent-free soap and re-washed all the clothes I’d washed with the scented soap, my rash went away. I now carefully read the ingredients of all soaps I buy to make sure they don’t have any fragrance or scents added. – Juan, age 31
What is contact dermatitis?
There are two types of contact dermatitis. The causes and symptoms of the two are nearly the same:
Irritant contact dermatitis. This type occurs when people touch something they’re sensitive to (called an irritant). It is the more common type.
Allergic contact dermatitis. This type occurs when people touch something they’re allergic to (called an allergen). People with allergies react to things like cosmetics, detergents, and latex that don’t affect most people. If they come into contact with something they’re allergic to, they may have symptoms.
What causes contact dermatitis?
Irritants and allergens that can cause contact dermatitis include:
- Dye used in clothing, fur and leather products
- Fragrances and perfumes added to products, such as soaps, fabric softeners, deodorants, body creams, cosmetics, tissues and toilet paper
- Hair coloring
- Latex, which is used in things such as plastic gloves, waistbands, bras, condoms, toys and balloons
- Medicines, especially antibiotic creams with neomycin
- Nickel found in many metal products, such as jewelry, zippers, buttons, and kitchen utensils (Even chrome-plated objects and 14K and 18K gold contain nickel that can irritate the skin if the gold gets moist.)
- Nail care products, including nail polish, nail hardeners and artificial nails, which can cause a rash when they are wet and touch the skin
- Soaps and cleaning products
- Poison ivy and other plants
Many of these irritants and allergens are found in the workplace.
Did you know...Some products cause contact dermatitis only when they touch the skin and are exposed to sunlight? They include sunscreens, antibiotics applied to the skin, shaving lotions, some perfumes and oil from the skin of a lime. A few things that are released into the air, such as ragweed pollen and insecticide spray (a chemical that kills bugs), also can cause contact dermatitis.
What are the signs and symptoms of contact dermatitis?
It’s often hard to tell the difference between irritant and allergic contact dermatitis, because the signs and symptoms are similar. Usually contact dermatitis symptoms occur within 10 days of the first time a person comes in contact with an irritant or allergen he or she is sensitive to. The next time that person touches that irritant or allergen, he or she may have symptoms within one or two days. The longer the skin touches the irritant, the more severe the reaction may be.
Symptoms can range from mild to severe on the area of skin that touched the irritant or allergen. These may include:
- Redness and swelling
- Itchy bumps or blisters that may ooze fluid
- Warm or hot to the touch
- Cracking or peeling of the skin
How can your allergist find the cause of contact dermatitis?
You’re allergist will review your medical history, and ask questions about your symptoms. Typical questions may include:
- In the past 24-48 hours before the rash, where were you and what were you doing?
- What kind of products, such as soaps and cleaning products, did you use?
- Have you had this type of rash before?
Your allergist will then do a physical examination and may order some lab tests.
Your allergist may ask you to stay away from all possible things that may have caused your rash. Then you would gradually be in contact with one thing at a time to see if your rash returns. If you get a rash, you’re likely sensitive or allergic to that item.
If your allergist thinks an allergy may have caused your dermatitis, he may do allergy skin testing to find out what you may be allergic to. The skin test that may be done is the patch test. This test shows whether someone is allergic to things such as latex, hair dyes or perfumes. A patch containing the possible allergen is placed on the skin and worn for 24 to 48 hours. If you’re sensitive to an allergen, your skin may become irritated and itch.
What should I do if I think I’ve touched an irritant or allergen?
- Wash your skin with soap and cool water as soon as possible to get rid of the irritant or allergen.
- Wash your clothing in hot water, and clean off your shoes with rubbing alcohol and water if you think these things touched the irritant or allergen.
How is contact dermatitis treated?
- Don’t scratch your rash. This can cause an infection or scarring.
- Continue to bathe with soap and water daily.
- Soak a washcloth briefly in cool water mixed with a couple of tablespoons of baking soda. Wring out the cloth and then place it on the rash.
- Put a medicated lotion, ointment, or cream on the rash, such as calamine lotion or Burrow’s solution or cortisone cream. These medicines can be bought without a prescription.
- Call your allergist for prescription cortisone cream to relieve the itching. Cortisone creams that can be bought without a prescription sometimes are not strong enough to help.
- Take an antihistamine if the other methods don’t stop the itching.
- Call your allergist if the rash is near your eyes, covers a large part of your body, or you can’t stop the itching. Your allergist can prescribe medicines to help you.
Other people can’t catch your rash
They can even touch your rash and blisters and not get the rash. If you have poison ivy, poison oak or poison sumac, once you’ve washed the oil off your skin, other people can’t get a rash from you.
How can I avoid or limit contact with things that can cause contact dermatitis?
Here’s a list of things that often cause contact dermatitis and what people who are sensitive to these things can do to avoid them. Read the labels of things before you buy them to make sure they don’t contain any ingredients you may be sensitive or allergic to.
Cleaning products or other chemicals
- Wear heavy-duty vinyl gloves with cotton liners when you’re handling these products or chemicals.
Fragrances and perfumes
- Look for fragrance-free or scent-free products and read the list of ingredients. Products labeled “hypoallergenic” or “unscented” may contain small amounts of fragrance.
- Your allergist may recommend a kit that can be used to test things for nickel.
- Cover things that contain nickel and may touch your skin with clear nail polish.
- Your allergist may recommend special sprays.
- Always use surgical steel for any object that pierces the skin, such as an earring.
- If you’re sensitive to nickel, don’t eat foods that contain traces of nickel including nuts, chocolate, beer, tea, coffee and apricots.
- Tell your doctors, dentists and anyone using rubber gloves about your latex allergy. Ask them to put a note in your medical chart about your allergy and remind them of your allergy before you have any medical procedures or tests.
- Don’t use latex gloves.
- Ask people you work with not to use latex gloves when you’re around or at least to use gloves that don’t have powder in them.
- Check the labeling on all products before you use them. Don’t use them if they say “latex” or “natural rubber.” The label “hypoallergenic” doesn’t mean “latex-free.”
- Use a synthetic latex condom.
- Be aware that people with latex allergy also may have allergic symptoms if they eat certain foods, such as bananas, avocados or chestnuts.
Nail care products
- Make sure these products don’t touch your skin when they’re wet.
- Consider not using these products.
Things that react with sunlight
- Check with your pharmacist or doctor to find out if any medicines you take could cause a rash when you’re in the sun.
- If you’re allergic to PABA, a chemical added to some products including sunscreen, use non- PABA products. Look for chemical-free sunscreens.
Who can treat my contact dermatitis?
Your allergist can treat your contact dermatitis.
Do health insurance plans cover treatment for contact dermatitis?
Most health insurance plans cover contact dermatitis treatment and treatment for allergies. Ask your insurance carrier:
- Do I need a referral from my doctor to see an allergist?
- Does my insurance cover patient education or special services for my allergies?
- Does my insurance cover a pre-existing problem? This usually means any health problem that you had before you joined your current health plan.
- What allergy testing and medicines does my plan cover?
- Are allergy shots covered? For how long?