Making Contact: Understanding Dermatitis

New York Yankees left fielder Alex Verdugo was in the news this summer, but not for his batting average. Verdugo has spent the last three years trying to find the cause of his itchy hands that blister and scab. The Yankees medical staff suspected contact dermatitis, a condition that occurs when your skin is exposed to a substance to which you have developed a sensitivity and sent him to an allergist to find out what was causing his symptoms.

Allergy providers consider two main types of contact dermatitis:

  • Irritant contact dermatitis accounts for 80% of all contact dermatitis, according to the National Eczema Association. It doesn’t involve the immune system. Rather exposure to irritating substances from detergents and bleach to nickel-containing jewelry damages skin cells.
  • Allergic contact dermatitis (ACD) is a delayed allergic reaction that appears as a rash a day or two after skin is exposed to an allergen because the body generates a robust inflammatory response.

Through testing, an allergist determined that Verdugo is allergic to his batting gloves. Chromate and cobalt are two metals used when making leather batting gloves and were causing his ACD.

How It Happens

Contact dermatitis can be difficult to diagnose as triggers can be familiar allergens that haven’t caused an issue in the past. Verdugo has many tattoos covering his chest and arms, which may have triggered his allergy since the pigments contain cobalt and nickel, says Dr. Susanna Silverman, a board-certified allergist and immunologist at Schweiger Dermatology Group. “It’s possible Verdugo became sensitized to the materials used in his tattoos, which may have included metals.” She adds, “Repeated exposure to a material, such as a metal, can sometimes lead to sensitization, so the immune system overreacts to the material on future exposures.”

Typical symptoms of contact dermatitis include redness, itching, blisters, red bumps, leathery skin, swelling and inflammation, usually localized to areas that are exposed to the allergen. Triggers can be airborne as well. Droplets of allergens in fragrances, cleaning products, hairsprays are common causes of eyelid dermatitis. Diagnosis isn’t straightforward because symptoms rarely appear on immediate contact. It may take hours or days to have a reaction.

Finding the Culprit

Allergy testing is the first step to determine what is triggering the symptoms. “Typically, patch testing is the best way to determine what is causing contact dermatitis, says Dr. Silverman. “A patient’s history may give some clues, such as rashes that occur with use of certain jewelry or with hair dye. However, skincare products, cosmetics and other commonly used household products such as detergents and soaps may contain many different ingredients. It can be difficult to determine the culprit allergen without doing patch testing,” she adds.

“We use the North American 80 Comprehensive Series for the initial patch testing because it covers a wide variety of contact allergens that were specifically selected by experts in contact dermatitis as the most common contact allergens in North America,” explains Dr. Silverman.

The patches are applied to the back with tape and removed after 48 hours. The site is evaluated for redness, blistering, and pustules, which if present, indicate a reaction. Patients return to the office twice — one day after the patches are removed and again a week later — to check for any lingering reactions.

Treat It Well

Once the allergen is found, the next step is to treat the irritated skin with creams, antihistamines or ointments to relieve the itching and help heal the skin. Acute contact dermatitis is typically treated with topical steroids. In severe cases, oral steroids may be necessary. Symptomatic treatments such as cool compresses can also provide relief. Wet dressings may be recommended for oozing skin, while antibiotics may be prescribed for secondary infections that can result.

When to See an Allergy Provider

Verdugo waited three years to see an allergy provider, but Dr. Silverman encourages anyone with dermatitis symptoms to seek help sooner. “If symptoms are recurrent or worsening, and if over-the-counter medications and avoidance measures are not helping, it is a good idea to see an allergy provider at that point,” she says. Once your allergy is identified, your provider can recommend safe products and advise on how to avoid triggers.

Top 10 dermatitis allergens and where to find them:

  • Nickel: Jewelry, buckles, clothing snaps, dyes and surgical instruments.
  • Neomycin: Topical creams, powders, ointments, eye and ear drops.
  • Balsam of Peru: Perfumes, deodorants, cosmetics, flavorings and topical medications.
  • Fragrance: Skin care products, perfumes and medications.
  • Thimerosal: Vaccines, antiseptics, contact lens solutions and cosmetic products.
  • Gold: Jewelry, dentistry and electronics.
  • Quaternium 15: Hand and face creams, lotions, shampoos, latex paints, polishes, adhesives and inks.
  • Formaldehyde: Dyes, textiles, leather hides, cosmetics, nail polishes, shampoos, deodorizers, glues, paints, plastics, adhesives, dry-cleaning and fertilizers.
  • Bacitracin: Topical creams, powders, ointments, eye and ear drops.
  • Cobalt: Paints, alloys, dental fillings, glass, zippers and utensils.

*Ranked by the North American Contact Dermatitis Group

Susanna Silverman, MD, is a board-certified allergist and immunologist at Schweiger Dermatology Group. She treats both adults and children for allergies (including seasonal and pet allergies, medication allergies such as penicillin, and food allergies), asthma, hives, eczema and some immunological conditions. She tailors her evaluation and treatment of each patient to fit their specific needs. Her unique experience gives her the ability to think outside the box in trying to find the underlying cause of her patients’ symptoms.
If you think you have allergy, schedule an appointment with one of Schweiger’s board-certified allergy specialists. They perform different types of precision testing to determine whether a particular allergen is at play and provide a customized treatment plan so you stay comfortable and healthy.

About Schweiger Dermatology Group

Founded by Dr. Eric Schweiger in 2010, Schweiger Dermatology Group began as a single office in Midtown Manhattan with a mission to deliver high-quality dermatologic care without long waits. As demand grew, so did the practice. Today we have over 120 locations across 8 states with more than 400 of the nation's leading providers and were ranked as the number one practice nationally in cosmetic and reconstructive care by Castle Connolly. In 2023, we broadened our expertise by integrating allergy care into our services. We remain committed to offering exceptional medical, cosmetic, and surgical dermatology as well as comprehensive allergy services, ensuring patients receive expert care in a modern, state-of-the art environment.

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