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NY, NY December 2005 - The cause of a skin rash (dermatitis) can be tough to figure
out-even for dermatologists. That's where patch testing comes in handy, according
to leading dermatologist and founder ofAdvanced Dermatology P.C. and The Center
for Laser and Cosmetic Surgery PC, Joshua L. Fox, MD. "Patch testing of the skin
can tell us if a rash is being caused or exacerbated by an allergy," he says, "and
can help us to distinguish a skin allergy from other skin conditions, such as eczema,
irritant dermatitis, or psoriasis."
Skin allergies occur when your skin comes into contact with substances called allergens.
Some people have immune systems that are hypersensitive to these substances. Common
allergens include nickel (in jewelry), rubber (especially latex), dyes, preservatives,
medications (such as antibiotic ointments), cosmetics and fragrances, and poison ivy, oak, and related plants. When an allergy is to blame, a red, itchy, inflamed
rash will appear on the body in the areas where the skin has met the allergen. "If
you're allergic to nickel and wear a necklace that contains this metal, you will
usually develop a rash around your neck." however, if you're allergic to latex and
wear latex gloves, you will usually develop a rash on your hands although you can
develop an allergic reaction throughout the entire body and in rare cases can be
life threatening," Dr. Fox explains.
In contrast, the cause of eczema, a chronic skin condition that inflames the skin,
causing pain, itching, dryness, swelling, cracking, weeping and scaling, is unknown.
In addition, eczema can affect any part of the body, but typically occurs on the
sides and back of the neck, and the insides of the elbows, knees and ankles in children
and on the hands of adults. "The two conditions can also coexist, and a skin allergy
may worsen eczema," reports Dr. Fox. Recently it was reported that patients with
atopic dermatitis have an increased risk of contact
allergies. They therefore require
thorough patch testing to help them avoid offending allergens. A new service offered
by the American Contact Dermatitis Society in coordination with manufacturers through
its website for its members allows the dermatologist to tell the patient which cosmetic
or other products they can use which does not have allergens.
What is patch testing?
Patch testing is a simple diagnostic procedure performed at a dermatologist office.
Small amounts of a number of common allergens are applied to the back and then covered
with a bandage. The test is typically left on for two days, and the patient is asked
to return to the doctor's office so as to see which of the allergens, if any, have
caused a reaction. Ideally for the best results the clinician may also ask the patient
to return again one to several days later to see if there are any additional / new
reactions to the allergens or a change in the previously recorded reaction, New
patch test regions allow us not to test to many things that previously went undetected
like gold.
Before testing, patients should tell their doctors about their jobs and hobbies,
since they can come into contact with unique allergens while handling materials
specific to these activities. It's also important to list the cosmetics and toiletries
they use, in case they are the source of the rash. That way, testing can be customized
to an individual patient's exposures. In addition, recent trips or other unusual
activities should be stated.
"Before patch testing, patients should not use any oral antihistamines or topical
corticosteroids, such as hydrocortisone or other creams, lotions, or ointments,
on their backs for 1 week, and they shouldn't expose the area to the sun," advises
Dr. Fox. While the patch test is on the back, measures should be taken to avoid
getting the panel wet while showering or some of the test substances may be washed
away. It's not uncommon to experience itching and burning in the test area after the allergens are applied, according to Dr. Fox, but patients should try not to
scratch the skin, as that can inflame it and make it difficult to interpret the
test results. "If these symptoms become severe, the doctor should be contacted for
guidance," he adds.
Treating skin rashes
Topical steroid creams and/or oral antihistamines & emollients can often be
enough to make a mild allergic skin rash disappear, says Dr. Fox. "More severe cases
may need to be treated with oral or injected corticosteroids, or other drugs that
can reduce inflammation and stop the allergic reaction." Other agents utilized include
Protopic®, Elidel®, Mimyx® and Atopiclair. Of course prevention is the best course.
"Once a patient knows he or she is allergic to something, avoid that allergen at
all costs to prevent the rash from recurring often in a more severe presentation.
A patient must avoid at all costs something he or she is allergic to, in order to
prevent the rash from reoccurring often more severely then the fist time.
Bio: Joshua L. Fox, M.D., F.A.A.D.
Joshua L. Fox, M.D., is a leading authority in the field of dermatology with an
expertise in skin cancer, cosmetic surgery, and laser procedures. As an official
spokesperson for the American Academy of Dermatology and the American Society for
Dermatologic Surgery, Dr. Fox has been an expert resource on dermatologic topics
for numerous televisions networks, including ABC, CBS, CNN, NBC and Telemundo, talk
shows, radio stations, newspapers and magazines. Dr. Fox has served on the board
of the National Rosacea Foundation and has done clinical trials in both medical
and laser therapy in rosacea. He has received multiple research and clinical awards,
including recognition from Top Doctors, Who's Who, Journal of Dermatologic Surgery
and Oncology, Community Service Award from the American Society for Dermatologic
Surgery, the prestigious Husic Award, as well as certificates of recognition for
service from multiple hospitals and civic, educational and community organizations.
Dr. Fox has authored and presented papers of his research on lasers, cosmetic procedures,
stretch marks, scars, skin cancer, bug bites, photosensitivity and various rashes.
As founder and director ofAdvanced Dermatology P.C. and The Center for Laser and
Cosmetic Surgery Dr. Fox and associates have expanded the practice to one of the largest
in dermatology, laser and cosmetic surgery, with more lasers than any hospital or
dermatology practice on the eastern coast. Dr. Fox is a graduate of the New York
University Medical Center of Skin and Cancer and has been on the advisory board
of the Psoriasis Foundation and National Rosacea Foundation, among others. He has
also been a fellow of many societies, including the International Academy of Cosmetic
Surgery, International Academy of Cosmetic Dermatology and the Society for Investigative
Dermatology. Dr. Fox is the founder of the AAD Melanoma/Skin Cancer Prevention Program
in Queens, New York (since 1987). Dr. Fox has been Chief of Dermatology of several
major teaching hospitals, including Mt. Sinai Hospital of Queens and Jamaica Medical
Center, and is currently on the staff of ten NY area hospitals. Dr. Fox and Advanced
Dermatology have been used as a
resource center educating dermatologists, laser surgeons and cosmetic surgeons and
others about lasers, cancer and cosmetic surgery.
www.advancedd.com.
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