By James G. Marks, Jr., MD, Peter Elsner, MD, and Vincent A. Deleo, MD (Auth.)
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Extra resources for Contact & Occupational Dermatology
Shoe or glove allergy). , it is the same intensity at all areas of exposure I. Allergic contactdermatitis does notaffectthe palms and soles. is probably based on a misunderstanding that allergenicity is related to toxins or infective agents in "cheap" products. A most confusing situation relates primarily to cosmetic and personal care products like skin and body lotions. For example, an individual suspects, probably correctly, that a reaction is developing to a specific cosmetic, so she changes to a different brand of cosmetic once or multiple times.
Fallacy: If change in consumer product exposure does not leadto clearing of the rash, that product is not etiologic. Truth: Manyproducts contain the same or cross-reacting antigens; also the composition of productsmay bealtered withouta change in tradename of product. Fallacy: Contact allergyalways occurs only at the site of exposure to the offending agent. Truth: The dermatitis is usually most severe at the siteof exposure, but because allergens may be carried to othersites, dermatitis may bemore widespread; because body sites differ in responsiveness to allergens, the most severe dermatitis may occur at a site distant fromthe primary exposure site.
A past history of skin disease, atopy, and general health is routinely investigated. This is followed by a detailed history of the usage of personal care products and cosmetics for skin, hair, and nails. The occupation should be ascertained; if that occupation appears causative, the occupational history can be taken. Patients may inadvertently give an inadequate history because they feel that some points are of no concern. Patients may even be hostile when the possiblllry of a contact allergy is suggested to them.