ALLERGIC CONTACT DERMATITIS

Contact dermatitis is a condition in which people develop an allergy to a product or substance that comes in contact with the skin.  The condition is usually manifested as a rash on the skin and can occur on the face and eyelids, a condition called eyelid and facial contact dermatitis.

The usual suspect: Nickle

A common irritant responsible for allergies includes nickle. Nearly 6% of Americans are allergic to nickel, making the silver-white metal the second most common cause of allergic skin rashes, behind only poison ivy. The incidence of nickel sensitivity among women is higher than the average, probably around 10 percent. Other common cosmetic ingredients responsible for allergic contact dermatitis:

• Preservatives (parabens, phenyl mercuric acetate, imidazolindnyl urea, quaternium-15, potassium sorbate)
• Resins (colophony)
• Pearlescent Additives (bismuth oxychloride)
• Antioxidants (butylated hydroxyanisole, butylated hydroxytoluene, di-tert-butyl-hydroquinone)
• Emollients (lanolin, propylene glycol)
• Fragrences
• Pigmented Contaminants (nickel)

An unusual suspect: Latex

Natural rubber latex is responsible for a recent and widespread outbreak of allergic skin reactions, ranging from mild irritation to anaphylactic shock. Latex reactions were rarely reported prior to 1970, but increasing numbers of reports since the late 1980's have led scientists to believe that increased exposure to latex products in recent years has caused more people to become sensitized. About a third of those who develop hives from contact with latex also develop such symptoms as asthma and even anaphylactic shock. This should lead people who suspect they are allergic to latex to have a professional diagnosis.

Finding the culprit

Finding the source of the allergy requires some good detective work. Have you recently changed fragrance? Have you use a new soap, shampoo, or laundry detergent? Has the same brand you've always used been reformulated? If you have recurrent problems, try keeping a diary of the products you use, and note when the symptoms start to appear and/or stop.

Should you develop a contact dermatitis, see your dermatologist for relief. He/she can perform a patch test to determine the irritating substance. If you suspect a nickel allergy, it is a good idea to have the dermatologist test for nickel sensitivity when considering having ears pierced. In any case, the piercing should be done with a stainless-steel needle. As a further precaution, stainless-steel or high-quality 18 karat gold studs should be worn as the first pair of earrings. Nickel sensitivity often does not result in a rash for weeks or months after contact with the metal. To further confuse the issue, a rash may not necessarily occur on the part of the body that makes contact with the metal.

HIVES (URTICARIA)

Hives are localized pink swellings (wheals) that occur in groups on any part of the skin. Each individual wheal lasts a few hours before fading away, leaving no trace. New hives may continue to develop as old areas fade. Hives can vary in size from as small as a pencil eraser to as large as a dinner plate and may join together to form larger swellings. When hives are forming they usually are very itchy, but may also burn or sting.

Hives are a very common medical condition; 10-20% of people will have at least one episode of hives in their lifetime. In most people, hives go away within a few days to a few weeks. Occasionally, however, a person will continue to have hives for many years.

When a hive forms around the loose tissues of the eyes, lips, or genitals, the tissue may swell excessively. Although frightening in appearance, the swelling goes away in less than 24 hours.

The most common foods that cause hives are:

1. Nuts                                 5. Chocolate

2. Fish                                 6. Tomatoes

3. Eggs                                7. Fresh Berries

4. Milk

Fresh foods cause hives more often than cooked foods. Food additives and preservatives such as tartrazine (yellow dye #5) may be responsible. Hives may appear within minutes or several hours after eating, depending on the site in the digestive track where the food is absorbed into the system.

Drugs

Virtually any medication (prescription or over the counter) can cause hives, but drugs that most commonly produce urticaria include antibiotics (especially penicillin), pain medications, sedatives, tranquilizers, and diuretics. It is important to realize that antacids, vitamins, eye and ear drops, laxatives, vaginal douches, or any other non-prescription item is a potential cause of urticaria. It is important for your doctor to be aware of all these preparations you use.

Infections

Many infections can cause urticaria. Viral upper respiratory tract infections are a common cause in children. Other viruses including Hepatitis B may also cause urticaria, as can a number of bacterial and fungal infections.

Chronic Urticaria

Bouts of hives lasting more than six weeks are termed chronic urticaria. The underlying cause of chronic urticaria is usually much more difficult to identify than that of acute urticaria. In many studies of patients with chronic urticaria, a cause can be identified in only a small percentage of patients. Your doctor will need to ask numerous questions in an attempt to identify a possible cause. You will also be asked to help in detective work. The amount of lab work performed by your doctor will vary with your history and examination. A patch test can be performed to determine the cause of hives. Lab work is may also be suggested.

Treatment

The best treatment for hives is to find the cause and then to eliminate it. Unfortunately, this is not always possible. While investigating the cause of urticaria, or when a cause cannot be found, antihistamines are given for relief. Antihistamines work best if taken on a regular schedule to prevent hives from forming. In severe cases of hives, an injection of epinephrine (Adrenalin) may be given. Oral cortisone preparations may also bring dramatic relief in severe cases, but their administration must be limed to short periods of time.

LYME DISEASE

Lyme disease is an infection that is caused by a corkscrew-shaped bacterium known as a spirochete. Unlike a lot of other infections, Lyme Disease may not be confined to one area of the body. It may begin as a simple skin rash but, if left untreated, can spread to the nervous system, the heart, and the joints.

Lyme Disease was first identified in 1975 in the town of Lyme, Connecticut. Since then, it has been found throughout most of the United States.

How do I get it?

Lyme Disease is spread by tick bites. These ticks live in or near wooded areas, tall grass, or brush areas. They hitch rides on household pets or other animals, which then bring the ticks into our own backyards. The ticks are always on the lookout to feed off birds, mice, deer, or humans.

The threat of Lyme Disease lasts from spring to fall, summer being the high-risk season. There are three regions of the country where most of the cases have been reported: Northeast, the upper Midwest, and the Northwest.

How do I know if I have Lyme disease?

Probably the most noticeable sign of early Lyme disease is a rash the often looks like a bull’s-eye, or an expanding red circle with lighter area in the center (where the bite occurred). This sometimes burning or itchy rash is called erythema chronicum migrans (chronic migrating red flush), or ECM for short. It often appears on the thigh, in the groin, or in the armpit. ECM doesn’t always look like a bull’s-eye; it sometimes appears as a single red rash or many small rashes.

Other signs of early Lyme Disease are flu-like symptoms such as malaise, fatigue, chills, fever, headache, and sore throat and enlarged glands. If the disease is not treated promptly, it may ultimately involve the heart, the nervous system, and the joints. Symptoms involving the heart include lightheadedness, fainting, rapid heartbeat, and difficult or labored breathing. Nervous system symptoms include headache, stiff neck, difficulty concentrating, poor memory, dizziness, earache, numbness, or visual disturbances. Lyme disease can cause arthritis in the joints-most often in the knees-and can sometimes, but rarely, leave permanent damage.

Important: Not everyone gets every symptom. Some may develop late disease symptoms such as arthritis without ever having experienced early disease symptoms such as ECM and fatigue.

How can I prevent Lyme Disease?

The old adage “an ounce of prevention is worth a pound of cure” bears keeping in mind. If you don’t let the ticks bite you, you can’t get Lyme disease. Here are some ways to prevent tick bites.

• Stay clear of wild animals
• Stay clear of tall grass, shrubs, trees, and other potentially tick-infested areas.
• You may wish to consider using insect repellents containing DEET (listed as diethyl-meta-toluamide). Repellents containing permethrin are also effective.
• Wear long pants, a long sleeved shirt, and a hat-all light colored (easier to spot ticks)-when going into “risky area.” Also, make sure pants are tucked into socks.
• Make body checks after any outdoor activity, and look for “moving freckles,” especially on children.
• Get tick collars for dogs and cats. Also inspect pets regularly for ticks.

Treatment

Lyme disease can be treated very effectively in the early stage. Certain oral antibiotics (tablets or capsules) have been shown to be effective for adults. Pregnant women and children are usually treated with Penicillin. Patients in later stages of Lyme Disease may require antibiotics injected into muscles or veins. Although antibiotics play an important role in treating Lyme Disease once it occurs, prevention is really the best treatment.

PITYRIASIS ROSEA

Pityriasis rosea is a common, harmless skin disease. Pityriasis rosea often begins with the appearance of a scaly, large, pink, "herald" or "mother" patch on the chest or back. This is followed by more pink, oval patches on the body, arms, and legs within a week or two that may assume the outline of an evergreen tree with drooping branches.

The cause is unknown, but we do know that:

• A single scaling spot often appears 1-20 days before the general rash. The rash covers mainly the trunk, but may spread to the thighs, upper arms, and neck. Pityriasis rosea usually avoids the face; sometimes a few spots spread to the cheeks.
• Pityriasis rosea is not contagious.
• Pityriasis rosea clears up in about three to six weeks, sometimes a little longer. When clear, the skin returns to its normal appearance. There will be no scars.
• About half of those afflicted with pityriasis rosea also experience severe itching. Some experience tiredness and aching before the rashes fade.
• Pityriasis rosea is not related to food, medicines, or nervous upsets.
• Pityriasis rosea always disappears by itself.
• While pityriasis rosea may occur at any age, it is most common between the ages of 10 and 35 years .
• Second attacks of pityriasis rosea are rare.

POISON IVY, SUMAC, AND OAK RASHES

Poison ivy rash is really an allergic contact dermatitis caused by a substance called urushiol, found in the sap of poison ivy, poison oak, and poison sumac. Urushiol is a colorless or slightly yellow oil that oozes from any cut, or crushes part of the plant, including the stem and the leaves.

You may develop a rash without ever coming into contact with poison ivy, because the urushiol is so easily spread. Sticky and virtually invisible, it can be carried on the fur of animals, on garden tools, or sports equipment, or on any objects that have come into contact with a crushed or broken plant. After exposure to air, urushiol turns brownish-black, making it easier to spot. It can be neutralized to an inactive state by water.

Once it touches the skin, the urushiol begins to penetrate in a matter of minutes. In those who are sensitive, a reaction will appear in the form of a line or a streak of rash (sometimes resembling insect bites) within 12-48 hours. Redness and swelling will be followed by blisters and severe itching. In a few days, the blisters become crusted and begin to scale. The rash will usually take about ten days to heal, sometimes leaving small spots, especially noticeable in dark skin. The rash can affect almost any part of the body, especially areas where the skin is thin; the soles of the feet and palms of the hands are thicker and less susceptible.

Recognizing poison ivy

Identifying the plant is the first step toward avoiding poison ivy. The popular saying “leaves of the three, let them be” is a good rule of thumb, but it’s only partially correct. Poison oak or poison ivy will take on a different appearance depending on the environment. The leaves may vary from groups of three, to groups of five, seven, or even nine.

Poison oak is found in the West and Southwest, poison ivy usually grows east of the Rockies, and poison sumac east of the Mississippi River. The plants grow near streams and lakes and wherever there are warm humid summers.

Poison ivy grows as a low shrub, vine, or climbing vine. It has yellow-green flowers and white berries. Poison oak is a low shrub or small tree with clusters of yellow berries and the oak-like leaves. Poison sumac grows to a tall, rangy shrub producing 7-13 smooth-edged leaves, and cream colored berries. These weeds are most dangerous in the spring and summer. That’s when there is plenty of sap and urushiol content is high, and the plants are easily bruised. Although poison ivy is usually a summer complaint, cases are sometimes reported in winter, when the sticks may be used for firewood, and the vines for Christmas wreaths. The best way to avoid these toxic plants is to know what they look like in your area and where you work, and to learn to recognize them in all seasons

Treatment

If you think you’ve had a brush with poison ivy, poison oak or poison sumac, follow this simple procedure:

1. Wash all exposed areas with cold running water as soon as you can reach a stream, lake or garden hose. If you can do this within five minutes, the water will neutralize or deactivate the urushiol in the plant’s sap and keep it from spreading to other parts of the body. Soap is not necessary and may even spread the oil.
2. When you return home, wash all clothing outside, with a garden hose, before bringing it into the house where resin could be transferred to rugs or furniture. Handle the clothing as little as possible until it is soaked. Since urushiol can remain active for months, it’s important to wash all camping, sporting, fishing or hunting gear that may also be carrying resin.
3. If you do develop a rash, avoid scratching the blisters. Although the fluid in the blisters will not spread the rash, fingernails may carry germs that could cause infection.
4. Cool showers will help ease the itching and over-the-counter preparations, like calamine lotion, or Burrow’s solution, will relieve mild rashes. Soaking in a lukewarm bath with an oatmeal or baking soda solution is often recommended to dry oozing blisters and offer some comfort. Over-the-counter hydrocortisone creams will not help. Dermatologists say they aren’t strong enough to have any effect on poison ivy rashes.

In severe cases, prescription corticosteroid drugs can halt the reaction if taken soon enough. If you know you’ve been exposed and have developed severe reactions in the past, be sure to consult your dermatologist.   She may prescribe steroids, or other medications, which can prevent blisters from forming.

TINEA VERSICOLOR

Tinea Versicolor is a common rash usually found on the upper body and arms in the form of slightly scaly discolored spots and patches. It is caused by a fungus which is found on nearly everyone’s skin, but causes a rash only on certain people. Why one person gets the rash and another person does not is unknown. Exposure to the sunlight or perspiration may make the rash worse, but it is very uncommon for it to spread to the face. It usually does not produce itching or other symptoms.

Preventing Recurrences

Since the fungus is very common, it is quite possible to develop the rash again. Vigorously scrubbing the upper body and arms once a week with a selenium sulfide shampoo (Selsun Blue) or a zinc-pyrithione shampoo (Head and Shoulders) or a similar brand may prevent recurrences. If the rash develops again in spite of this measure, please see a dermatologist.

Treatment

The Cheyenne Skin Clinic offers two common treatments:

• Oral medications. Antifungal medications are the most effective method to kill the fungus. Be aware that even if the fungus has been killed, a blotchy discoloration may persist for several months.
• Topical treatment . A topical treatment with selenium sulfide is available. The over the counter strength is not usually strong enough, but a prescription strength is available. After an evening shower apply the selenium sulfide lotion to the skin of the trunk from the neck down to the waist or knees and on the arms and wrists. Allow it to dry and wash it off in the morning in the shower. Repeat this application once a week for one month. Also use the lotion to shampoo the scalp once a week.