Skin rashes can disrupt our daily lives and at times be a source of constant irritation. If you are constantly itching I know it can be very difficult to focus on anything else. In severe cases, it can even prevent sleep. Sleep deprivation can then cause a ton of other complications, and can make someone pretty miserable.
As a dermatology physician assistant, I see and treat many different types of skin rashes. A skin allergy rash otherwise known as an allergic contact dermatitis can be at times difficult to treat. This can be made especially difficult when we don’t know where the allergen is coming from.
My goal in this article is to educate you on the steps I typically take my patients through in order to help relieve their itching and also to help figure out what is causing their annoying rash. The majority of the time this step-by-step approach will treat the rash. The knowledge of knowing where it is coming from will also prevent future outbreaks.
Recommended: 6 Vital Steps of an Optimal Full Body Skin Care Routine
Step #1: How I treat an allergic contact dermatitis
I first start by having my patients discontinue all of their normal skincare products. This does not mean they need to throw anything away, in fact, I don’t want them to. We will talk about what we do with all of their skincare products later in this article.
I have them do a strict cleanse of anything they use around the house for an entire month or until the rash clears up, whichever comes first. This includes many different things for example: laundry detergent, cleaning supplies, body washes, moisturizers, jewelry, makeup, perfume, etc.
A lot of patients will say: “but I have been using these products for years and have never had a problem before.” Just because someone has been using the same thing for years does not mean they can’t develop an allergy to it. I have had many patients discontinue something they have used for a long time to find out that their rash goes away.
Once they have put all of your normal products to the side, I then have them start a routine of only using hypoallergenic products. I have listed a few substitutions I like to recommend to my patients.
- Laundry detergent: All free and clear laundry detergent.
- Body wash: Dove bar soap
- Moisturizer: Cetaphil cream, CeraVe cream, or plain Vaseline
Typically, if an allergic contact dermatitis is bad enough I will prescribe a prescription-strength topical steroid. The over-the-counter option for topical steroids is hydrocortisone 1%. It is a fairly weak over-the-counter treatment option but at times can be enough to help treat a rash especially if the offending allergen has been discontinued. The other over-the-counter treatment that can be helpful with allergies and itching would be an antihistamine such as Zyrtec or Allegra.
Step #2: How to determine what is causing your skin allergy rash
Common allergens can include ingredients in scented products. I always recommend discontinuing anything that has a scent to it. Yes, that means your Bath and Body Works lotion has to go! Other common allergens can include things such as gold or nickel like what is found in jewelry, belt buckles, and the buttons on your jeans. If your rash is located solely in those areas then you may be allergic to one of those metals.
If you have a high suspicion about your moisturizer or body wash you can do a self-test at home by applying it under a bandage behind your ear. This is a sensitive part of the body and will react a little quicker when you apply it under occlusion. Obviously, you don’t want to do this test with your laundry detergent, which brings me to the next option for determining what you are allergic to.
After your rash has cleared you can start incorporating your normal products back into your routine. BUT and this is a big but, you must do it one at a time. I would give it a week or two after you restart one thing before you restart another product. This way you’ll be able to determine which product causes your rash to recur. If you were to start ten things back at one time and your rash recurred then there would be no way to tell which is the culprit.
Step #3: If no improvement then what?
If you are not experiencing any improvement after several weeks, then it is probably time to consider patch testing. Patch testing is when a medical provider (typically at a dermatology medical provider) checks for common allergens that you may be coming into contact with. These ingredients can be found at home and in different working environments. It can be very useful information if someone does test positive.
There are different types of patch testing out there. The one I use at work is T.R.U.E. testing which includes 36 common allergens. The allergens are applied to your upper back. You can’t get your back wet after the patches have been placed so no showers for a few days. It is also important that you have been off systemic steroids for at least two weeks or else you may not react.
Besides allergens you can come into physical contact with, there are other types of allergens that can cause rashes. This includes food allergens and environmental allergens. Sometimes I will also check blood work to check for common food allergies including different types of nuts, seafood, and dairy. When it comes to environmental allergens the best person to see is an allergist. Allergists can do much more detailed testing for environmental allergies. They can test you for allergies to certain types of plants, trees, grass, mold, and dust.
Conclusion
When in doubt about a skin allergy rash I always recommend seeing a dermatology medical provider. While you may believe your rash is due to something you are coming into contact with, it may very well be due to something else. There are a million things that can cause rashes: from medications to autoimmune conditions to cancer. If you are not seeing improvement by trying to treat it on your own, it is very important you don’t wait any longer and that you go seek out help from a medical provider. You can always start with your primary care provider, and they will point you in the right direction.
If you did find that this step-by-step approach successfully treated your skin allergy rash please comment below and let me know what you were allergic to! If you have an allergy to something then that means someone else out there probably does as well.
*Disclaimer: Opinions expressed are solely my own and do not express the views or opinions of my employer. Information on this website is for education and entertainment purposes only. Content is my opinion. It is not substituted for your own doctor’s medical care or advice. One should not make any health or medical-related decisions based in whole or in part on any content on this site. Content is not intended to replace the services of a licensed, trained health professional. Content may not apply to you as an individual. Although I will update my website with current information, this website is not a definitive guide to dermatology.
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