A simple patch test to reveal if you are allergic to your beauty products30.08.2022
One of the hottest weeks in New York City’s summer was spent without the ability to shower. My back was nearly covered with surgical sticky tape, which was reinforcing large adhesive patched filled with allergens that made my skin itchy. Even more bizarre was the fact that I prayed fervently for itchy flare-ups for the remainder of that week. You are now ready to skin patch-test.
My skin reacts strongly to any new products in hair-care or skin-care. My skin can become red and itchy, causing raised welts and a grainy rash that can last for weeks. To avoid irritants from scents, I try to use mostly non-fragranced skin care. However, it’s not foolproof and I have more flare-ups than I would like.
I was desperate to find out what my skin reacts to so I visited Hudson Dermatology and Laser Surgery, New York City, to see Tamara Lazic Strugar MD. Tamara is a dermatologist who specializes diagnosing skin allergies using skin patch-testing. This is the best way to discover both common and severe allergies.
What are skin allergens exactly?
Dr. Lazic Straugar explains that a skin allergen is any chemical that is applied to your skin. This causes your immune system to think your skin is under attack and produce antibodies to combat the allergen. The result is contact dermatitis, which is a red, itchy rash. The most common allergens include poison ivy and nickel in costume jewelry. Contact dermatitis can also be caused by skin-care and personal-care products that contain fragrances or preservatives.
There are two types: allergic and irritant contact dermatitis. Irritating Contact Dermatitis (ICD), is a type of skin irritation that can occur minutes to hours after contact with harsh cleaning products. It causes burning, stinging, and pain. Allergic Contact Dermatitis is caused by an allergic reaction to chemicals that touch your skin. The rash can develop after contact with an allergen. It can take several days for this to occur so it is difficult to pinpoint the source.
According to Lindsey Bordone MD, a dermatologist who is board-certified and the director of medical dermatology at Columbia University Medical Center, skin allergies can cause a variety of problems. Sleep disturbance is the most common complaint I hear from patients. They may wake up itchy or unable to sleep if they have severe itching. She says this can affect their work performance as well as their happiness.
Although it may seem minor, chronic pain can have devastating consequences for those suffering from it. Patients who have experienced both pain and debilitating itching over the years tell me that their itch is more severe. Dr. Lazic Stragar suggests that it is harder to manage and pain can be easier medicated. “My job is very important when I find the answer and remove the culprits so that the patient does not get another rash. It’s the best scenario, and it happens often.”
What is skin patch testing?
A patch test is a way to determine if a person’s skin reacts to various substances in their daily life. It involves applying purified allergens on the skin to assess if there are any.
Dr. Lazic Straugar says that patch testing is the best and most accurate method of diagnosing allergic contactdermatitis. A dermatologist or allergist can perform the test. They will place pre-made patches containing individual allergens on the skin. The patches are placed on the patient’s unbroken, clean skin. They are then left in place for 48 hours to allow the allergens to remain in constant contact with their skin. To keep track of the locations of the patches, the patches are removed and the back marked with a Sharpie. The True Test is a simpler patch test that measures sensitivity to 40 allergens. However, Lazic Strugar considers this a short-cut and recommends the intensive version that tests for at least 90 allergens.
To check for positive reactions, the skin is examined around 72 hours or 96 hour after patch placement. The back must remain dry throughout the entire time. This includes no showering or bathing. Sponge baths that don’t wet your back are not allowed. Exercising is discouraged as the patches must adhere closely to the skin.
My own patch test was not very pleasant. I was hot all the time and couldn’t shower so it was quite painful. Although I was able to tolerate sponge baths, I miss the refreshing feeling of taking a cold shower after a long day. However, I was determined to find my allergen(s) and I persevered. This should not be done in high summer, but it should be easy.
Are you a candidate for patch testing?
Dr. Bordone explains that when we see patients with worsening skin conditions, even if they don’t have a history of eczema or a family history, we often start to look at environmental triggers that might be causing the rash. Before testing, dermatologists will carefully examine the location of the rash and the duration of redness or burning. Positive patch tests are most effective for recurring, itchy bumps or rashes on the hands or face.
Dr. Lazic Stragar may not recommend testing if the reaction is affecting both your hands and feet. Her diagnosis might be more towards eczema and psoriasis. These conditions are more systemic and symmetrical and often affect palms and soles. Dr. Lazic Stragar says that ACD means that allergens may be touching only your hands and feet, but not the rest.
Another example of proper placement is: If the scalp is itchy and the skin rash is on one side or the other, this is usually due to shampoo or conditioner. A rash on the front or side of your neck or on the forehead could be from perfumes. It is worth testing patients with rash at these spots.
Dr. Lazic Stragar believes that everyone who is suffering from eczema needs to have a patch test. You may find that your eczema symptoms don’t really stem from eczema.
Dermatologists diagnose eczema as a broad term for itchy rashes. This includes contact dermatitis. Itchy, flaky, and it doesn’t matter where it is coming from, then it’s likely eczema. A skin biopsy will not tell you the source of itchy, flaky skin. Therefore, I recommend that everyone suffering from eczema have it tested. It’s a quick and easy way to find out. You don’t have to suffer from a rash every day if you discover you are allergic to fragrances. It is possible to get a diagnosis of allergic dermatitis (which is often genetic) and have it removed.
She says that patients with skin allergies are more likely to have flare-ups. Although they may still experience flare-ups due to stress or other triggers, the likelihood of them developing skin allergies will drop significantly if the triggers are removed.
What happens next after a patch test is complete?
Dermatologists who specialize in patch testing can provide information to the patient about the allergens they are allergic to. They also give the names of any other manufacturers so that they can advise what products to avoid. The patch testing and subsequent allergy avoidance may be able to provide a solution rather than merely managing a chronic skin condition with medicated creams and prayer.
I returned to the office for my reading after my 96 hour appointment. Unfortunately, none of the 90 allergens I was exposed to caused me to react. Dr. Lazic Stragar said it was more likely that I had irritant contact dermatitis. “Almost 80 percent” of cases of dermatitis can be referred to as irritant, not allergic. This means that your skin is sensitive and may become irritated by some things, which will not necessarily be visible on a patch test. Dr. Lazic Stragar also noted that my skin was the only one showing symptoms, and not my entire body. This makes it less likely that it is an allergic reaction. She adds that true allergy will be visible wherever allergen touches your skin.
Dr. Lazic Straugar was able to diagnose me more easily with my test, but she is often faced with cases that require some detective work to determine where patients might have been exposed to their allergen and how it can be eliminated from their daily life. One patient’s patch test showed a strong positive result for ethylenediamine. This is a rare chemical. After asking the patient about her hobbies and work, she discovered that she was a yoga instructor. Although the high-end yoga mat she purchased didn’t have ethylenediamine listed, Dr. Lazic Stragar called the company to get a complete list. He was finally able to find out that ethylenediamine was on the list.
She explains that she was rubbing the allergen onto the mat when she was sweaty. Others such cases were also caused by sulfites found in beer. One baker’s severe hand eczema was the result of daily contact with Balsamof Peru, an ingredient in cinnamon, while kneading dough.
Dr. Bordone saw a patient recently with red, swollen eyes. She had switched all her makeup products with new brands and stopped using eye makeup. However, she was still reacting to the routine. It turned out to be the rubber in her makeup sponges. She suffered with it for more than a year before we diagnosed the rubber allergy.
What are the most common allergens found in beauty products?
Preservative and fragrance ingredients are both common triggers for personal-care and beauty products. Methylisothiazolinone, commonly called MI, tops the list, according to Dr. Bordone, along with Paraphenylenediamine (PPD), which is widely used in permanent hair dyes that frequently causes severe allergies. They can occur all over the body, and people often don’t realize that the hair dye is responsible for them. Dr. Lazic Strugar says that severe eyelid swelling can cause a rash and can be seen all over the body.
Allergy-inducing fragrances, whether synthetic or natural, that contain essential oils can be caused by both synthetic and artificial perfumes. Two common triggers are limonene and linalool, both citrus-derived fragrance compounds. Dr. Lazic Strugar states that patients who receive skin-care products from Whole Foods, and they believe it isn’t causing their rash are mistaken. However, essential oils can be very sensitizing.
These allergies can develop over time. People may notice allergies after consuming a product for months, or even years. It’s not uncommon for people to become allergic to the product after so many years of consistent use. This is due to a phenomenon known as cumulative exposure. It’s usually how ACD develops. It doesn’t happen the first time you touch something. Dr. Lazic Strugar says that your body must see it at least twice before it becomes sensitized and then produces a memory immune response each time it sees the chemical.
Neosporin allergy is a very common example. Neosporin, a topical anti-bacterial, is now a product dermatologists are condemning. Neomycin, the active ingredient, can be very sensitizing. People tend to use it a lot, often slathering it onto chapped or cracked skin. She says that if you apply it to an already damaged skin barrier, it is more likely to cause an allergic reaction. Before you start to think that all your beauty products are irritating your skin, consult your allergist or dermatologist to determine if a patch test might be necessary.