Allergies : Uncovering the Cause of Contact Dermatitis

Sarah Bowman

Katie Branic has changed the brand of makeup she uses more than a dozen times.

The 23-year-old also recently switched to baby shampoo and even dropped gluten from her diet.But no matter what Branic does, she can't stop the red, scaly rash that forms on her eyelids and around her lips.

"I can tell you lots of tears were shed from frustration over this," said Branic, an information-technology analyst for a Columbus-area financial institution. "Makeup couldn't cover it up anymore. I had to do something."

Branic, of Worthington, has contact dermatitis, an allergic reaction caused by direct contact with a substance.

The red, itchy rash you get after touching poison ivy is contact dermatitis. So are the bumps caused by latex gloves. Those are easy ones.

The list of substances that can cause the condition is seemingly endless. And to make matters worse, anyone can become allergic to nearly anything at any time.

That's why contact dermatitis ranks among the top 10 reasons people visit primary-care physicians and is among the most-common reasons for work-related disability.For doctors and patients alike, the condition can be frustrating. Creams, lotions and even steroids can help control symptoms, but the underlying cause and its effects might linger for years.Branic had seen three doctors.

None could help. Then she was referred to Dr. Matt Zirwas, a dermatologist and director of Ohio State University's Contact Dermatitis Center.

"Contact dermatitis kind of falls between the cracks between allergists and dermatologists, so it goes unnoticed and not treated so many times," said Zirwas, who has spent the past eight years dedicated to solving mysterious rashes.The work has earned him a reputation among colleagues and his staff.

"I call him the Sherlock Holmes of skin allergies," said Denise Close, Zirwas' physician assistant. "He will figure out the allergies no one else has been able to."

But before we get to how Zirwas cracks the tough cases, it's important to look at why patients end up in his office.Susan Nedorost, the president of the American Contact Dermatitis Society, said one reason is that most rashes don't appear right away. And many are caused by something a patient has used for years.

But what makes it even more difficult is that most people aren't allergic to one product. Instead, they are allergic to specific chemicals, some that stretch 20 letters long and are nearly impossible to distinguish in most physician offices.One textbook contains more than 1,000 pages of substances that can cause contact dermatitis.

"It's very difficult for patients to deduce the cause -- much harder to be their own detective," said Nedorost, a professor of dermatology at Case Western Reserve University in Cleveland.Few dermatologists do the skin-allergy work that Zirwas does to track down the cause of a patient's contact dermatitis.

Patients travel to Ohio State from Pennsylvania, Kansas and even Alaska to see him.

Over the years, Zirwas has tied allergies to the glue in a patient's shoes, dyes in clothing and even a chemical found in the black rubber on escalator hand rails."It's the hidden exposure in everyday things," he said.

Once patients get to Zirwas, they undergo an initial consultation to figure out what to test for. Then they undergo patch-testing, during which discs that contain potential allergens are taped to their backs for two days to see what they react to.Branic recently was tested for 103 allergens.

Zirwas said he is focusing on chemicals in the makeup and fragrances she wears.She said she is tired of having to take off work because of the rashes.

"It's so unpredictable, and I always have my fingers and toes crossed that it won't flare up," Branic said. "But that's no way to live life."

So far, Branic has learned that she is mildly allergic to a few fragrances. But Zirwas isn't convinced those are the only culprits.He said he will continue to work with Branic until he cracks the code. Once he does, she will be told how to find products that don't contain any allergens that trigger her rashes.

"For the people who have this, it's one of the very, very few things in medicine we essentially have a cure for," Zirwas said. "There's nothing else where we can say, 'Just make these changes, and you will never have to deal with this ever again.""

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