Plants:

• Poison ivy, hyacinth, tulips, ragweed, etc.

Chemicals:

• Pesticides, insecticides, and fertilizers.

Over-the-counter drugs:

• Poison ivy remedies containing benzocaine and zirconium.

• Lotions and liniments to soothe burns, sunburn, and pain.

• Athlete’s foot medications.

• Hair removal products for legs, underarms, and bikini areas.

• Analgesic balms and liniments for burns, sunburn, and pain.

• Depilatory agents.

• Tar preparations for psoriasis and eczema.

• Acne lotions, scrubs, and gels.

• . . . and hundreds of others.

If you take a look at where a rash appears, you can usually figure out what might be the cause. For example, if the rash is on your face, you should suspect cosmetics, nose drops, sprays, eyeglass frames, and over-the-counter lotions, creams, and ointments. On the earlobes, consider earrings containing nickel (almost all do), hair dyes and sprays, perfumes, and other scented lotions. Necklaces, hair dyes and sprays, collars, scarves, etc can cause a rash on the neck. In the armpits, consider antiperspirants and deodorants.

For contact dermatitis of your legs and feet, think of socks, stockings, pants, and shoes, as well as plants such as poison ivy.

Colored or perfumed toilet paper, jock itch medication, feminine hygiene sprays, scented tampons, pads and panty liners, douches, hemorrhoid treatments, suppositories, and birth control creams and devices could cause irritation in the genital or anal area.

Some of the most stubborn allergies show up on the hands. Soaps, cleansers, detergents, gloves, plastics, and hundreds of metals, plants and chemicals could be the reason for the rash.

Some of the more common products that are responsible for allergic contact dermatitis are: nickel (found in almost all metal products including jewelry, particularly earrings), rubber (especially latex), chromium compounds (in cement, leather paints, shoes), and scores of others.

The following pages include a discussion of three common forms of contact dermatitis: poison ivy dermatitis, cosmetic contact dermatitis, and occupational dermatoses.

POISON IVY DERMATITIS

“eaflets three, let it be” is an old poetic warning. To which let me add my own unpoetic, “Don’t be rash with poison ivy.”

The three-leafer is the most common cause of contact dermatitis in the United States. More than 80 percent of all Americans are sensitive to plants of the poison ivy family. Poison ivy grows in most of the central and eastern parts of the country as low- lying shrubs or high-climbing aerial plants. It frequently appears under trees and poles and along fencerows. (It sometimes grows as ornamental shrubs in gardens!) The poison ivy plant has thin, pale stems upon which are three shiny, waxy, spade-shaped and pointed leaflets. (If you suspect that a plant is poison ivy, grasp it with a piece of folded white paper and crush it. If it’s poison ivy, the sap on the paper will turn black in five minutes.) Poison ivy leaves turn red in the fall, and clusters of white berries form at their base.

Other related plants that can cause “poison” rashes are poison oak and poison sumac. Poison oak grows as a small shrub with clusters of yellow berries and the characteristic oak-like leaves; it is found mainly on the West Coast and accounts for 25% of all reported workmen’s compensation cases among lumberjacks, utility line workers and fire fighters. Poison sumac, flourishing in swamps and peat bogs along the eastern seaboard, grows as a tall, rangy shrub producing 7 to 13 leaves with cream-colored berries. The plants grow as vines on walls, fences, trees, telephone poles, and other vines, or as ground shrubs of various sizes.

Despite its name, poison ivy is not a poison. And, contrary to popular myth, the rash is not contagious. The sap of all these “poison” plants contains an allergic substance – one that can cause skin rashes in susceptible individuals. You get the rash by rubbing against or in some other manner exposing yourself to the plant. The allergic chemical in the plant – a sticky, colorless-to-yellow oil called urushiol – acts as a foreign material (antigen) on the skin, stirring up a defensive mechanism in your body. Your skin responds by forming certain “protective” cells (antibodies). This combination of the foreign and protective substances stimulates your immune system resulting in the redness, blisters, and itching that we call poison ivy dermatitis.

You don’t have to come in direct contact with a poison ivy plant to develop a poison ivy rash. You can get it by touching shoes, various articles of clothing, sports equipment, and other objects that came in contact with poison ivy. You can get it by petting an animal whose fur may have been contaminated from bushes. The active ingredient in the poison ivy plant can remain active for months or years on inanimate objects, long enough to induce a rash if those substances are later touched. And you can get poison ivy dermatitis on your eyelids and face just by burning the leaves, due to active material in the smoke.

Following contact with the plant, a rash will develop in almost everyone. If you have a history of previous poison ivy episodes, then your rash can appear within a few hours after exposure. If you have never had poison ivy dermatitis before, the rash may take two to three weeks to develop after the initial exposure.

The rash that develops from poison ivy begins as redness, followed by small blisters, usually in streaks, accompanied by itching. The exposed areas of the skin – usually where the greatest amount of exposure has occurred – are most often affected: the hands, forearms, and face. The eruption may become severe, with marked swelling of the eyelids, widespread skin involvement, fever, and secondary infection.

Although poison ivy dermatitis is not contagious, the chemical responsible for the rash remains active after the initial contact. You yourself can spread the rash to other parts of your body within the first hour after contact. After one hour on the skin, however, this chemical changes so that no further contamination will occur. Inanimate objects, such as clothing and camping equipment, can retain the substance for months, thus producing the rash when least expected.

Poison ivy dermatitis knows no season. More cases, however, occur in late spring and early summer, when the plant sap is most abundant in the stem and leaves. Your sensitivity to poison ivy changes with time and tends to decline with age.

Treatment for poison ivy dermatitis depends upon the severity of the eruption.

If you know you have come in contact with one of these “poison” plants, thoroughly wash yourself with a laundry detergent and water as soon after exposure as possible. Preferably within ten minutes. While this will not prevent an outbreak of the rash, it may help minimize the spread. Make sure you wash under your fingernails, too. And wash all contaminated clothing, sports and garden equipment, and animals.

In mild, fairly localized cases, warm water compresses and plain calamine lotion (do not use other, over-the-counter “poison ivy remedies”) will help dry up the tiny blisters and relieve the itching.

In more severe and extensive cases, it is advisable to see a dermatologist. The latest approved treatment, and one that promises to stop the rash in its tracks, is high-dose therapy with cortisone-like drugs. This should be done early, as soon as the little bumps appear on the skin, and before the allergenic substance has a chance to sensitize the skin cells.

At the present time, there are no safe, approved methods of desensitizing people who are allergic to poison ivy.

The treatment for mild cases of poison ivy dermatitis is the same as the treatment for all allergy rashes.

To protect against these “poison” plants, first learn to recognize their physical characteristics so that you can avoid them when you are outdoors. In addition, wear protective clothing when hiking or weeding: long sleeves, high socks, and gloves. And never burn poison ivy plants; the resin can be carried in the smoke and land on your skin or in your eyes.

ALLERGY RASHES DUE TO COSMETICS

In our society many women – and men, too – go to great lengths to look good and smell good. The myriad products on the market that claim to help us retain our youthful, healthy looks reinforce this pursuit.

The marketers of cosmetics – those who prey on women’s insecurity – use various claims extolling their particular products. These allegations include the following:

• “Hypoallergenic”. All this means is that it doesn’t have any fragrance, which is the most common cause of allergic rashes. Most cosmetics now proclaim that they are hypoallergenic.

• “Natural”. First of all, why should “natural” products be better than laboratory-synthesized substances? They aren’t! Then take a look at some of the so-called “natural” products and read the fine print on the label! In order for a product to stay on the shelf without becoming spoiled or rancid, preservatives must be utilized.

• “pH-Balanced”. Almost all cosmetics and hair-care products are pH-Balanced, meaning that they are less alkaline and therefore less irritating than some deodorant bar soaps and strong alkaline shampoos.

• “Antiaging”. All this means is that the product, usually a facial cosmetic, contains a sunscreen! Most of these antiaging cosmetics never list the sun protection factor (SPF), so you cannot know the relative degree of sun protection you are getting.

• “Rejuvenating”. Another term for “wrinkle creams,” this appellation is essentially meaningless. The ingredients for these “rejuvenating” creams vary, some including a sunscreen, others a moisturizer, and still others one of the new alpha hydroxy acid components.

• “Environmental Protectant”. Ostensibly to protect the skin from the sun and pollutants, they may contain a sunscreen and various antioxidants such as vitamin C and E which, when topically applied, are essentially worthless and can only provoke allergic dermatitis in many.

• “Dermatologist-tested”. A meaningless claim, since all cosmetic products are ultimately checked by dermatologists who are either retained by the cosmetic company to help formulate the product, or who are solicited in trials to determine whether they might be acceptable for some of their patients.

If you are a young woman, how many products might you put on your face, hair, body, and nails before you leave the house? From the top: On your hair you might use conditioner, color or tint, shampoo, crème rinse, setting lotion, mousse, and hair spray. Dye? Bleach? Relaxer? Permanent-wave solution? In the bath you might use soap, bath oil, bath oil beads, bath salts, powder, and body lotion. And on your face – for starters – soap or cleansing cream and astringent, perhaps followed by moisturizer, foundation base, tinted base, shading cream, highlighting cream, contour cream, toner, freshener, clarifier, blusher, blotter, face powder, and mineral water spray. Your eyes are next – eye shadow, eyeliner, eyebrow pencil, eyebrow powder, and mascara. Eye circle concealer? False eyelashes and glue? Lash extenders? For your lips – gloss, rouge, and lip liner. How about sunscreen? And how about a powder with “body glitter?” Fragranced aromatherapy products?

Your fingernails and toenails will require a cuticle cream, base coat, nail conditioner, nail hardener, nail lacquer, nail gloss, and quick-dry solution. Artificial nails, perhaps? And don’t forget the depilatory, deodorant and antiperspirant, hand cream, feminine hygiene spray, and perfume.

Did I forget anything?

Would you believe that each product just mentioned – sixty-odd– could cause a skin allergy, hair breakage, or nail discoloration? There are about 8,000 chemicals that go into the making of cosmetics. You may use a cosmetic product for years without developing a reaction and suddenly become allergic to any of a number of the chemicals and preservatives, lanolin, dyes, and fragrances in it. In fact there isn’t a product on the market, including the so-called hypoallergenic varieties, which cannot at some time, in some person, produce an allergic reaction on the skin.

A word about those preservatives in all cosmetics: Preservatives are necessary evils in all consumer merchandise. Without preservatives, cosmetics – and other products – would break down, spoil, and allow harmful germs to set up housekeeping. One of the common culprits in bringing about allergic rashes is formaldehyde, a disinfecting agent that many people have become allergic to. A very popular preservative in cosmetics is quaternium-15, a substance that releases formaldehyde thus triggering allergies. Other common allergens and irritants include: parabens; lanolin; acrylates and toluene sulfonamide/formaldehyde in nail cosmetics; paraphenylenediamine in permanent hair dyes; para-aminobenzoic acid (PABA) in sunscreens, and a host of others.

A rash – dermatitis – does not always occur over the area where you apply a cosmetic. Dermatitis of the eyelids or neck, for example, is often due to hand creams, nail polish or hair spray.

Cosmetic dermatitis is common in young men, as well. The chief causes are shave creams, hair dyes, hair tonics, adhesives for hairpieces, bronzers, moisturizers, deodorants, soaps, sunscreens, and clear nail polish.

How can you tell if you have an allergy to a cosmetic, and what can you do about it? Determine what new products you may have been exposed to just before your rash appeared, and then eliminate all possible irritants. Change soaps to a mild, white, perfume-free variety. (Cetaphil Cleanser or Bar are excellent soap substitutes.) Stop all scented lotions, creams, and sprays. Don’t use any cosmetics for a week, and then gradually use them one at a time. Or, better yet, try to live without a lot of them. The fewer the chemicals you expose your skin to, the less chance of it being irritated or sensitized. You should also consider culprits other than what you yourself might be using. Have you been around anyone who wore a new perfume, cologne, or other scented toiletries? Anything new at the beauty shop or barber? At work? At school? The possibilities are infinite.

If you are unable to pinpoint the cause of your rash, your dermatologist will have the proper knowledge and equipment – patch testing, for example – to determine the cause. And unless you eliminate the cause, this allergy rash will forever plague you whenever you are exposed to your Nemesis.

OCCUPATIONAL RASHES

At last count, there were almost 150 million people working in more than 70,000 forms of employment – a staggering number of occupations. And there are literally thousands of different chemical, physical and biological agents in these 70,000 occupations that can be responsible for contact dermatitis and other skin ailments.

The skin has many functions, not the least of which is to protect us from a hostile environment that includes germs, irritants, blows, chemicals, temperature changes, and radiation. Yet despite the ability of the skin to withstand many of these onslaughts, it is still the most commonly injured organ.

Here are a few facts:

• Almost never life-threatening, skin eruptions account for about 75 percent of all medical diseases compensated for and is the number one in-plant cause of lost time in industry.

• Fully ten percent of all skin diseases in the general population are work-related in origin.

• The cost of skin diseases due to occupational exposure runs into the hundreds of millions of dollars a year in medical expenses and lost time (on the average of 11 days a year per affected worker) on the job.

• Four out of 5 cases of occupational contact dermatitis involve only the hands.

• Those who have suffered from eczema in childhood tend to be more prone to occupational contact dermatitis than others. Their hands frequently become aggravated in occupations such as hairdressing and machine operating.

Occupational dermatitis is defined as a “contact dermatitis for which exposure at work can be shown to be the main cause or one of the factors contributing to its occurrence.” Direct causes of occupational or industrial skin disease can be divided into seven groups:

1. Chemicals, the most frequent cause, include strong acids and alkalis, solvents, cutting oils, gases, and salts. All of these can injure the skin on direct contact, producing various kinds of rashes, while other chemicals, such as those found in leather, lacquer or rubber, can cause rashes that are allergic in nature.

2. Mechanical factors, caused by pressure or friction (prolonged use of pneumatic tools, such as air hammers and chisels) are responsible for cuts, bruises, calluses, and the like. Fiberglas can produce a mechanical irritation and an itchy rash.

3. Physical agents in the form of excessive heat, sunlight, wind, and cold can cause burns, sunburn, allergic reactions, and frostbite.

4. Bacterial and fungal infections can occur among meat handlers, farmers, and grocers.

5. Insect bites and stings among outside workers are common dermatologic afflictions.

6. Bites from snakes and wild animals may arise in zookeepers, outdoor workers, garbage men, and mail handlers.

7. Poisonous plants and woods, as well as other vegetation, can cause skin problems among gardeners, farmers, road builders, surveyors, forestry workers, and telephone linemen.

There are hundreds of products and chemicals in industry that can cause dermatitis in otherwise healthy people. Almost anything can be responsible, but certain occupations are more susceptible than others to contact dermatitis.

The following are some common occupations and material used in these jobs that are responsible for rashes:

Artists: Turpentine, solvents, clay, plaster, paint, sprays, ink.
Auto mechanics: Solvents, cutting oils, paints, cleansers, greases, kerosene, lacquer.
Bakers: Flour, spices, cinnamon, nuts, lemon, flavorings.
Barbers and hairdressers: Soaps, shampoos, permanent-wave solutions, hair dyes, rubber gloves, bleaching agents.
Bartenders: Detergents, cleansers, citrus fruits.
Bookbinders: Glue, plastics, solvents.
Building trades people: Cement, epoxy resins, rubber and leather gloves.
Butchers: Detergents, meats.
Canning industry: Juices, dyes, preservatives, brine.
Carpenters: Polishes, glue, solvents, cleansers, adhesives, wood.
Clerks and office workers: Carbon paper, glue, typewriter ribbons, copy paper, rubber, nickel, glutaraldehyde.
Cooks: Meat and vegetable juices, spices, detergents.
Dentists and dental technicians: Resins, acrylics, fluxes, mercury, rubber and latex gloves, local anesthetics.
Dry cleaners: Benzene, turpentine, carbon tetrachloride.
Electricians: Rubber, tape, glues, solvents, soldering flux.
Exterminators: Arsenic, DDT, formaldehyde, pyrethrum.
Florists and gardeners: Fertilizer, pesticides, plants (tulips, chrysanthemums, narcissus).
Food industry: Vegetables, spices, rubber gloves, detergents.
Foundry work: Oils, hand cleansers, resins, plastics.
Garment and millinery industries: Dyes, turpentine, benzene.
Groceries and delicatessen: Dyes on labels, insecticides, cardboard boxes, paper bags.
Hospital workers: Soaps, detergents, disinfectants, rubber gloves, penicillin, streptomycin.
Household workers: Detergents, polishes, solvents, rubber gloves, sprays.
Jewelers: Solvents, nickel, enamel, chrome.
Laundry workers: Detergents, bleaches, solvents, turpentine, starch, antiseptics, soap.
Manicurists: Nail polish, acrylic nails, cosmetics.
Masons: Cement, acids, resins, rubber and leather gloves.
Medical technicians and nurses: Detergents, plastics, solvents, antibiotics, antiseptics, anesthetics, formalin, rubber gloves.
Metal workers: Cutting oils, cleansers, solvents.
Painters: Turpentine, thinners, solvents, paints, dyes and adhesives in wallpaper.
Paper manufacturers: Glues and pastes.
Photographers: Acids, solvents, formaldehyde, dyes, color developers.
Plastic industry: Solvents, acids, additives, hardeners.
Platers: Solvents, paints, chromium, acids and alkalis.
Plumbers: Oils, hand cleansers, rubber, cement, nickel.
Printers: Solvents, glues, turpentine, paper finishes.
Rubber workers: Solvents, rubber, dyes, tars.
Shoemakers: Solvents, glues, leather, rubber, turpentine, cement, polishes.
Sporting goods: Lead, rubber, nickel, chrome, leather, dyes.
Textile workers: Solvents, bleaching agents, fibers, dyes, finishes.
Theatrical profession: Cosmetics, dyes, glues.
Undertakers: Formaldehyde, embalming fluids.
Welders: Oil, chromium, nickel.
Window shade makers: Paint, benzene, shellac.
Woodworkers: Woods, turpentine, lacquers, varnish, tars, paints.

What is particularly sobering is that we can control and prevent fully 90 percent of all occupational dermatoses by using protective clothing and cleansers.

The cure of contact dermatitis depends largely on detection and removal of the cause. This search for the causes can be one of the most intricate tasks confronting an allergist or dermatologist. But once we have discovered the causative agent, it is relatively easy to cure the rash and prevent recurrences.

• An allergy develops when your body overreacts to a foreign substance. On the skin, it often takes the form of redness, itching, swelling, and sometimes blistering.

• A contact dermatitis is a redness or inflammation of the skin that results from actual contact with a variety of natural or manufactured materials.

• Just about one out of every ten patients who see a doctor for some skin problem will find out that he or she has an “allergic contact dermatitis.”

• The three-leafer – poison ivy – is the most common cause of contact dermatitis in the United States. More than 80 percent of all Americans are sensitive to plants of the poison ivy family.

• Contrary to popular myth, poison ivy dermatitis is not contagious or infectious.

• There isn’t a cosmetic product on the market, including the so-called hypoallergenic varieties, that cannot at some time, in some person, produce an allergic reaction on the skin.

• Cosmetic dermatitis is common in men, as well. The chief causes are shave creams, hair dyes, hair tonics, adhesives for hairpieces, bronzers, moisturizers, deodorants, soaps, sunscreens, and clear nail polish.

• Skin eruptions account for about 75 percent of all medical diseases compensated for and are the number one in-plant cause of lost time in industry.

• The cost of skin diseases due to occupational exposure runs into the hundreds of millions of dollars a year in medical expenses and lost time on the job.