Contact Dermatitis: Cracking the Mystery Behind Your Red, Itchy Skin

In January 2022, Liz, previously a nurse at Penn Neurology for 16 years and currently a PICC nurse at Jefferson Hospital, was plagued with red, itchy rashes which mysteriously appeared on her left hand. Within a month, the problem spread to her right hand as well as her face. A steroid cream provided by Liz’s primary care doctor proved ineffective, and by spring, she was covered with bright red rashes up to her elbows.

“Not knowing what was causing the problem was so frustrating,” says Liz. “I tried eliminating fragranced products such as laundry detergents, soaps, shampoos, conditioners, lotions and perfumes—giving up everything I enjoyed. I tried medications that knocked me out of balance, but nothing worked.” Unable to identify the source of the serious skin rashes and no longer able to perform her job, she contacted our office.

Liz is not alone. Millions of people suffer from contact dermatitis, a condition triggered by the body’s protective immune response to a perceived skin irritant and causing inflammation. If an individual is exposed to the irritant often, they can become allergic to it. You have a higher risk of developing an allergic reaction if you work or live in an environment where you are repeatedly exposed to a substance that irritates your skin. The cause of the itchy, red, and sometimes bumpy rashes on your skin can remain a mystery, as it can take days for a rash to appear.

Common items that may contain irritants include cosmetics, hair dye, fragrances, costume jewelry, sunscreen and lip balm. Plants such as poison ivy, poison oak, and poison sumac are notorious for outbreaks. Some metals are also culprits, as well as chemicals in latex gloves, balloons, pacifiers, and medicines. Clothing is frequently a source of irritation as your skin reacts to dyes and chemicals used to manufacture the garment. Synthetics are more likely than natural fibers to pose a problem because they don’t breathe as easily. And beware permanent press clothes, because chemicals like formaldehyde that are used to help reduce wrinkles are often a trigger.

Symptoms

The most common symptom appears in the form of a red rash, concentrated where the irritant made contact with the skin. Along with a rash, you may experience one or more of the following symptoms:

• Itching
• Tenderness
• Hot, burning or stinging skin
• Dryness
• Hives
• Blisters
• Pain

Testing to Identify the Irritant

Because it’s difficult to pinpoint the source of the irritant, a patch test can prove valuable and eliminate the guesswork. The process is relatively easy. Approximately 80 adhesive patches that contain small amounts of the most common irritants are gently placed on the patient’s back. The allergist will check your skin after 48 hours and again after another 48 hours, looking for reactions to any of the irritants, andꟷin most casesꟷwill identify the source of the contact dermatitis.

Treatment

While avoidance of the irritating substance is best, once you have an outbreak and you have confirmed it is contact dermatitis, you can use over-the-counter antihistamines or anti-itch creams to soothe minor symptoms. For more severe cases, your doctor may prescribe corticosteroid topical creams or oral steroids.

Although extremely rare, if an allergic contact dermatitis reaction triggers anaphylaxis, call 911 or administer injectable epinephrine.

Tip: For people with sensitive skin, it may help to choose fragrance-free moisturizers, soaps and cleansers, as well as clothing made from natural fibers in lighter colors that use less dye.

The good news is that today, simple contact dermatitis patch testing can solve the mystery behind unexplained skin outbreaks by identifying the allergens and substances that cause them. Our board-certified allergists at Chestnut Hill Allergy & Asthma Associates can support you to learn what your triggers are so you can keep your skin calm and happy.

After administering patch testing to Liz, we were able to identify the trigger of her contact dermatitis. Testing revealed that she was allergic to a component that is used in the manufacturing of the gloves she was wearing at work. Now that Liz is aware of the triggers to avoid, her skin remains clear. Free of the debilitating itching and redness that she experienced, she says, “For the first time, I feel hopeful.”