Did you ever develop an itchy, scaly rash after wearing a new pair of earrings? Or suffer an unsightly facial breakout after frequent cell phone conversations?
Millions of Americans are affected by contact dermatitis, an allergic skin reaction characterized by itchy red bumps or crusted skin. Some reactions can be treated at home, but resistant cases account for up to 7% of dermatology visits. In the workplace, 90% of dermatologic workers’ compensation cases result from contact with skin allergens.
Only 20% of contact dermatitis cases are true allergies, in which a chemical reaction causes the body’s immune system to release histamines. The rest are irritations, skin sensitivities that do not trigger the immune system, although reactions are visually the same, says Christy Riddle, MD of Baylor Medical Center in Garland, Texas.
“Allergies can occur at any point, and repeated exposure may lower a patient’s allergic threshold,” Riddle adds.
Metal and Other Culprits
“The most common metal for allergic reactions is nickel,” says Lisa Garner, MD, dermatologist at Children’s Medical Center in Garland, Texas.
Avoiding nickel is challenging. It is in nearly all silver-colored metals, Garner says. Metal covers on cell phones contain nickel as do clasps, buttons, hooks, zippers, buckles, eyelash curlers and facial tweezers. Women are especially susceptible because many have pierced ears and wear costume jewelry.
To avoid an itchy rash, Sarah Ludwig, 35, of Chelsea, South Dakota, sticks to jewelry made from stainless steel, sterling silver or 14-karat gold. “I’ve had problems with the backs of metal buttons on jeans, which I’ve painted with clear nail polish until it wears off and needs a fresh coat,” Ludwig says.
Although more people tolerate gold, white gold and 10- or lower-karat jewelry may be problematic because they contain nickel. Choose 18-karat gold if your skin allergies are severe, recommends Riddle.
Quaternium-15, a makeup preservative also found in paints, polishes, adhesives and waxes, is a prime cause of face and hand dermatitis. Even though balsam of Peru, a vanilla-like fragrance used in skincare and perfumes, is organic, it contains 250 substances, any of which can cause irritation.
“All creams and lotions, even those made from natural ingredients, must contain preservatives to prevent mold and bacteria from forming, and preservatives are among the most prolific causes of contact symptoms,” warns Garner.
Susan T. Nedorost, MD, a dermatologist with Case Western Reserve University in Cleveland, Ohio, agrees.
“Just because a product is ‘natural’ doesn’t mean it won’t cause an allergy.” Common sensitizers include bee glue or propolis, used in chewing gum and lip balm; lavender, used in moisturizers and shampoos; and botanicals such as peppermint oil or lemon grass oil, used in personal care products.
Nedorost cautions that “ingredients in hair care products can cause facial or neck dermatitis even if they don’t cause scalp dermatitis because the neck and face are more sensitive to run-off or incomplete rinsing.” Substances in baby wipes are known to irritate adult hands, and chemicals in henna tattoos are an increasingly frequent source of skin irritation.
Irritants can also cross categories. For example, antiperspirant ingredients that cause underarm itch are also found in snaps and buttons.
Sunscreen ingredients such as benzophenone, which blocks harmful ultraviolet radiation, can cause skin allergy. “Photo-contact dermatitis is common on the face and neck where sunscreen has been applied because UV light activates sunscreen,” Nedorost says.
Fragrance added for its therapeutic benefit, such as calming, and not just for its pleasant scent, doesn’t have to be listed on the label, and even so-called unscented products may contain masking fragrances, observes Garner. “That makes determining offending substances more difficult for consumers,” she says.
While metal items and personal care products may be the most common sources of skin allergens, they are only two of many. Allergic reactions have been reported to pine or epoxy resins used in mascara, bandage adhesives and hearing aids. Ludwig developed a severe rash when surgical tape was applied to her skin, so she now requests paper tape or bandages fastened with elastic bands.
Detergents and fabric softeners containing fragrances are common offenders. Acrylates found in eyeglass frames, dental resins and artificial nails can cause contact dermatitis, too.
“Chemicals used to make natural rubber latex or latex-free synthetic—which shows up in eye shadow applicators, foam makeup sponges and the rubber edge of eyelash curlers—are additional allergens,” says Nedorost.
Instead of healing that cut on your finger, the popular over-the-counter topical antibiotics neomycin sulfate or bacitracin could cause further irritation. Rather than using a triple antibiotic, Riddle recommends the double formulation.
Stress can exacerbate the effects of contact dermatitis because it slows the skin’s ability to recover from rashes and breakouts. As a result, inflammation occurs more easily and irritations last longer.
The cause of a reaction can be hard to pinpoint because your skin may not react to initial contact. Sensitivity to the substance often requires prolonged or repeated exposure, which means keeping an exposure timeline may help with identification.
If your own sleuthing doesn’t turn up the answer or if symptoms become chronic, skin patch testing by a dermatologist is recommended. You can also try eliminating gluten, a protein found in wheat and other grains, from your diet and see if that helps.
If you’ve identified the irritant, wash your skin thoroughly to remove any traces. To relieve redness and discomfort, apply topical hydrocortisone cream or petroleum jelly, or soak in a saline solution. Oatmeal baths, ice-cold compresses or antihistamines may relieve itching. Even by completely avoiding the irritant, redness from contact dermatitis may take weeks to go away. Be patient.
A number of natural remedies can be used to help ease inflamed skin. Aloe vera and calendula can be applied in topical form, while boswellia, available in both topical and supplement forms, is an anti-inflammatory used in Ayurvedic medicine to treat heat-generating disorders. Be sure your diet is rich in such skin-friendly nutrients as beta-carotene, vitamins C and E, and omega-3 fatty acids.
The best way to forestall future reactions is to avoid the offending substance. At-home test kits can check for the presence of nickel in metal objects. Using hypo-allergenic and fragrance-free products won’t eliminate the possibility of a reaction but may provide less exposure to potential irritants.
Allergic reactions can leave you red, itchy and uncomfortable. Learning how to ease the itch and avoid the irritant can make living in your skin a lot easier.