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November 2, 2007

Dear Patients,

Are you annoyed by chronic rashes that come and go?  Have you been diagnosed with contact dermatitis, but no specific cause has been identified?  I would like to tell you about a minimally invasive method which may determine the source of these rashes; this procedure is called Patch Testing. 

First, allow me to clarify the non-specific diagnosis of contact dermatitis.  Contact dermatitis occurs when a chemical comes in contact with the skin and causes a reaction.  There are two types of contact dermatitis: irritant and allergic.  Irritant contact dermatitis is your skin's response to harsh substances such as household cleaners, detergents, and industrial solvents, as well as dry, cold weather.  Typically, the skin becomes red, dry, or itchy in the area of contact within minutes or hours of exposure, and the reaction subsides soon after the irritant is removed or washed away.  Symptoms include dry, red, itchy or glazed (shiny) patches of skin.  These reactions are not caused by a true allergy. 

Allergic contact dermatitis, conversely, is a skin inflammation that is caused by an allergic reaction to a foreign substance.  It occurs after direct skin contact with allergens such as nickel, fragrances, and preservatives.  Symptoms develop each time you contact the allergen and can last for several weeks.  Contact dermatitis allergies can develop at any time, even to compounds you have been exposed to for many years.  Within my patient population, allergens found in make-up, skin and hair products, perfume, and jewelry are common culprits.

Since the symptoms of the two types of contact dermatitis are similar, it is often difficult to deduce the specific cause of your rash simply by looking.  This is where Patch Testing can be helpful.  The procedure for Patch Testing begins by taking common allergens, mixed with a vehicle such as Vaseline for dilution, and placing these allergens onto patches.  These patches are then placed on your back and taped in place.  The patches are removed two days later, and your skin is checked for possible reactions.  You may be required to return for a second reading the following day.  For the duration of the test, which can range from three to four days, your back and the patches must be kept dry to preserve the continuity of the testing materials.  The test is not painful, though some patients report itching and burning sensations.  However, typically the test is merely an annoyance, and nothing more.  The Patch Test is covered most insurance plans.       

Upon removal of the patches, two outcomes are possible.  In the case of a positive test result, one of the allergens from the test produces a reaction similar to the one that brought you to the doctor.  An allergy and possible cause of your rash has been isolated.  We will provide you with information on this allergen which will help you avoid products in which it is found, which may help alleviate your chronic rash.  In the case of a negative test result, no reaction occurs, indicating that you are not allergic to the most common allergens.  This is important information, as this minimizes your need to avoid common products and allows us to focus on other possible causes for your rash.

If you have questions about Patch Testing or would like to schedule an appointment to discuss this procedure, please contact our office at (212) 962-1115.  Click here to see an interview on CNN regarding contact dermatitis.

Barry D. Goldman, M.D.

2006 Allergan.