Indy Chabra's patients often think the red, itchy rashes on their skin are related to something they ate. They don't usually suspect that the things they wear, touch or clean themselves with could be causing the problem.
"They waste so much money going to the allergist and getting prick testing," the Dakota Dunes dermatologist said.
Nickel is the most common cause of allergic contact dermatitis in the United States. But everything from sofas made in China to volleyballs and formaldehyde-based products, Chabra said, can cause rashes which are often treated with a strong topical steroid.
"If you look at the back of shampoo bottle or any product, it'll say DMDM hydantoin or a bunch of other allergens," he said. "When you're allergic to any of this stuff you often have cross allergies."
Annually, the American Contact Dermatitis Society selects a contact allergen of the year. The 2013 allergen of the year is Methylisothiazolinone (MI), a powerful preservative increasingly found in cosmetics and toiletries, including wet wipes.
Infants and young children present at Midlands Clinic, 705 Sioux Point Road, with rashes after parents have tried numerous over-the-counter treatments. Chabra asks them if they've been using wet wipes. They stop. The rash clears up.
"Every time they use it, that's when the rash comes. You stop it, the rash goes away," he said.
Chabra asks patients suffering from allergic contact dermatitis if they've recently changed skin or hair care products. The answer is often, "No."
"Companies change the specific ingredients of products without telling people," he said. "Second, our immune system changes. Third, the skin changes. If the skin is broken down, the chances of it developing an allergic contact dermatitis is higher."
Chabra performs a T.R.U.E. test or epicutaneous patch test, to help him diagnose allergic contact dermatitis. The test's sticky panel, which is applied to the patient's upper back, contains tiny amounts of 35 allergens. Substances a person isn't allergic to, won't cause a skin reaction.
Gold, Chabra said, is the most common cause of eyelid dermatitis in women.
"Because the gold rings -- and a lot of the facial products they use have sunscreen in them -- have zinc and titanium. Titanium is a metal that upgrades little particles of gold. You're putting this on your face every day, and eyelid skin is some of the thinnest skin in the body. That's why you get eyelid dermatitis."
A women visited her ophthalmologist multiple times to rid herself of an eyelid rash, before coming to Midlands Clinic. Chabra performed a patch test, which he said "lit up for gold."
"Then we realized that the glasses have 14-carat gold," he said. "She changed them and she was fine."
Chabra also patch-tested a high school volleyball player suffering from a facial rash. It turns out that the teen is allergic to rubber accelerants used in the manufacturing process.
"To make rubber you take the sap and vulcanize it. Otherwise rubber is very gooey, and so you use all these accelerants in it," Chabra explained. "She was allergic to all of those."
Chabra contends that the teen is in a tough situation. He instructed her to wash her hands immediately after playing volleyball, and not to touch her face before she does.
"Allergic contact dermatitis is one of the more rewarding areas," he said. "You can figure it out and fix it."