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Saving Face: How to Find the Source of a Skin Rash

Teresa Tanoos's picture
How to find source of rash on face

If you’ve ever had a sudden rash that seemingly came out of nowhere, you know how frustrating it can be trying to figure out what caused it. One of the most common forms of rashes is contact dermatitis, which can cause a maddening itch on top of red, bumpy, scaly and flaky skin. And if you have facial allergic contact dermatitis – meaning the rash is on your face – it can be especially distressing.

From shampoos, cosmetics and fragrances to metals such as nickel, gold and cobalt, facial allergic contact dermatitis will continue until the source is known and no longer touching or being applied to the skin. Fortunately, dermatologists have the tools to identify the allergen and can help patients navigate their way to clear skin.

At the American Academy of Dermatology’s annual summer scientific meeting this week in New York – where world-renowned dermatologists are presenting information on the latest research in the diagnosis and treatment of skin, hair and nail conditions – Dr. Amber Reck Atwater, a board-certified dermatologist and director of the Contact Dermatitis and Patch Testing Center at Duke Department of Dermatology in Durham, N.C., addressed issues related to common symptoms of facial allergic contact dermatitis.

“People are not born with allergies, but rather allergies develop over time. Any chemical can cause an allergic reaction, so it is important to stop using a product that you suspect might be to blame and see your dermatologist for proper evaluation,” said Dr. Atwater. “Even if you have been using a product for several years and don’t think it could be the source, stop using it. Product manufacturers can change their formulas and include different chemicals – and they may not be required to tell you about it.”

The most common forms of facial allergic contact dermatitis include the following:

1. Eyelid Dermatitis. Redness, scaly skin or itching on the upper or lower eyelids, or both.

• Fragrance is a common cause from direct contact with shampoo, conditioner or makeup;

• Nickel is one of the most common causes from direct contact with eyelash curlers or tweezers and can also occur from direct application of a product such as eye creams or eye make-up;

• Indirect application occurs from an allergen transmitted via the hands, such as nickel, which attaches to a person’s hands from door handles or keys that can end up on the eye area if a person rubs their eyes;

• Indirect contact with fragrance can occur when fragrance oils remain on towels or pillows, or fingers and hands.

2. Lip Dermatitis. Scaly skin or itchiness occurs directly on the lips or around the lip area.

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• Nickel, preservatives and fragrance are the two most common causes and can occur from direct or indirect application of a product;

• Direct application includes lipstick, lip gloss, toothpaste, mouthwash, sunscreen or metal-containing products, such as a dental tools or jewelry • Similar to eyelid dermatitis, indirect application can occur from an allergen transmitted via the hands;

3. Run-off Pattern. This is an allergic reaction related to products used on the scalp, such as shampoo, hair dye, conditioner, detangler, perm solution, which are rinsed off the scalp and run down the face causing a reaction on other parts of the body.

• A rash can occur on the upper forehead, ears, the sides of the face and neck, and occasionally the chest.

Dr. Atwater also addressed the possible connection between mobile phones and facial rashes. She says that a rash appearing on the cheek and in front of an ear on only one side of the face may indicate an allergic reaction from nickel or chromium, which is found in certain models of mobile phones.

Dr. Atwater pointed out that many reported cases of mobile phone nickel-induced facial dermatitis have occurred in flip phones, but the newer smart phones are less likely to contain these substances on the outside. She added, however, that there has been one reported case of an allergic reaction occurring from a smart phone case or cover that contained silicone.

What can you do if you suspect your mobile phone is the source of an allergic reaction?

First, contact a dermatologist who can test your phone to find out if it contains nickel. Dr. Atwater says it’s important to learn what it is about the phone that is causing the rash. Then, replace that part of the phone or the entire unit with one that does not contain the allergen.

When a new, isolated rash appears on the face for no apparent reason and doesn’t clear up within a few weeks, Dr. Atwater recommends seeing a dermatologist to determine if an allergen is to blame. When thinking about what could cause a facial rash, she asks patients to consider their hobbies, the type of work they do and any products containing herbals, which they apply to their skin.

If a patient is unsure what product is causing the rash, a dermatologist can conduct a patch test in an effort to identify the source of the allergy. Patch testing involves exposing the skin to chemicals that commonly cause allergies to find out if one of them causes a reaction on the skin.

Once the allergen is correctly identified, the dermatologist can then prescribe the appropriate treatment. If the reaction is mild, a patient may try an over-the-counter hydrocortisone 1% cream or ointment to see if it’s helpful. In more serious reactions, a dermatologist may prescribe a topical steroid cream to the affected area. If the steroid causes side effects, Dr. Atwater said that other non-steroid creams also can be used successfully on a case-by-case basis.

Generally speaking, Dr. Atwater says that patients should expect to see an improvement in their skin rash two weeks after avoiding the allergen, although it could take up to eight weeks before the symptoms clear completely in some cases.

SOURCE: American Academy of Dermatology, News Release: "Saving face: Dermatologists helping patients identify source of facial allergic contact dermatitis," (Aug. 1, 2013)