Solving The Mysteries Behind Skin Disorders

When discussing contact dermatitis in his professional and teaching lectures . Charles Gropper, director, Division of Dermatology at SBH, often brings up a particular case study.

One winter, a woman came to see him complaining of a rash around her mouth. In discussing the possible causes of the rash with Dr. Gropper, she recalled that she first started noticing it shortly after the Christmas holidays.

“We discussed her condition a little more after which I suggested we do patch testing,” says Dr. Gropper. “The test comes back with a positive finding for epoxies contained in Scotch tape and Bacitracin.”

In true Holmesian fashion, worthy of a deerstalker hat and a meerschaum pipe, Dr. Gropper soon deduced that the patient had been preparing holiday gifts, wrapping them with Scotch tape that, because both hands were occupied, she cut with her teeth. Upon noticing a rash that formed around her mouth, she applied the antibiotic in hopes it would respond to it, only to later realize it only made it worse.

“For my lectures, I call it the case of ‘gift wrapping dermatitis,’” says Dr. Gropper, who adds that detective work often helps him get to the root of his patients’ skin conditions.

A Definition

Contact dermatitis occurs when a patient’s skin comes into contact with a substance in the environment that he or she is allergic to, causing the skin to become itchy and red. The two most common types of contact dermatitis are irritant and allergic. According to the National Eczema Foundation website, irritant contact dermatitis develops quickly when the skin touches an irritating chemical, is rubbed too hard, or comes in contact with heat. The result is dry, itchy and cracked skin. Allergic, which is the result of exposure to things to which the person has become allergic, may cause itchy rashes with swelling and sometimes blistering.

With allergic contact dermatitis the rash usually appears about two days after exposure, but can take up to 96 hours to develop a reaction. Classic poison ivy, for example, is referred to in the dermatologic lexicon as “Tuesday’s disease,” says Dr. Gropper, because people who go to the park on Sunday and brush up against poison ivy, are likely to develop the rash by Tuesday.

Contact dermatitis may also be the result of a diet heavy in nickel. The presence of this metal in the diet of a nickel-sensitive person can cause a dermatitis – with the hands most commonly affected, although other parts of the body may also show symptoms. Foods with high nickel content include whole wheat and grain, rye, oat, cocoa, chocolate, tea, baking powder, dried fruit, beverages, tuna, walnuts, tomatoes, onions, and raw carrots. Nickel-plated utensils can also add to the condition, as can physical contact with jewelry, keys or hairpins.

Patch testing, as performed by a dermatologist, is a delayed hypersensitivity test that can determine the specific allergen or irritant causing the response. In his office, Dr. Gropper applies eight patches to the patient’s back, each consisting of 10 tiny squares with small amounts of potential allergens that can cause reactions. “We leave them on for 48 hours to monitor the skin for reactions,” says Dr. Gropper, who adds that at times it may take 72 or 96 hours to determine results that may include allergies to substances found in anything from hair dyes, to toothpaste, to perfumes. The test is painless and does not involve needles.

Treatment for contact dermatitis often starts and ends with removal of the offending irritant or allergen. A barrier cream or gel can provide a protective layer of skin and moisturizers may help.

Atopic Dermatitis

Eczema, also known as dermatitis, is a broad term that covers a wide range
of skin conditions. Atopic dermatitis, or eczema, a condition also marked by red, blotchy and itchy skin, often develops in early childhood, but may occur at any age. Long lasting with a tendency to flare periodically, it may be accompanied by asthma or hay fever or certain food allergies, and tends to run in families. It can affect children as young as several months old, and most often affects the face, hands and folds of the skin behind the knees. Both steroid and non-steroid medications are used, as are moisturizers and gentle soaps. Excessive bathing or washing, which can exacerbate the condition, may also need to be avoided.

“For the first time in many decades, there have been major advances in treating eczema and its symptoms with a new”
“injectable biologic agent called Dupixent (generic name dupilumab),” says Dr. Gropper. “This has proven very effective.”

The medication, originally approved only for patients ages 12 and up, he says, will soon be available for younger patients as well.

“Eczema is a big problem in our community,” says Dr. Gropper. “We had a young man, 17 years old, who had eczema all his life. He had scaly, dark spots all over his body. It was really adversely affecting his life. He came to see us and we started him on Dupixent. The mother and child came back some time later and were crying because they were so appreciative. It was the first time in the kid’s life he was getting better.”

See a Doctor

Any form of dermatitis can effect one’s life. Dr. Gropper knows from personal experience how important it is to find answers and solve problems. Although his wife had been complaining of itching for about a year, he was convinced that it was simply a minor nuisance that would eventually disappear.

“I kept saying it doesn’t look like much because it wasn’t a typical rash she was getting,” he says. “I thought it was just dry skin. Finally, we decided to do patch testing. We found her to be positive for number 58 benzyl alcohol, which was in many products used by her hair person and also products she was using at home. Avoiding these products made a dramatic difference.”

He admits that this convinced him that “If you are having itchy rashes that are adversely affecting your life, don’t wait. Investigate it.””