Symptoms and treatment for facial allergic contact dermatitis

Overview: Facial rashes can take on many forms. Whether red, flat, bumpy and dry, or scaly, flaky and itchy, the appearance of a rash on the face can be very distressing. Even more challenging is figuring out what is causing the rash - possibly an allergy to one of the countless products, ingredients and chemicals people are exposed to every day. 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.

American Academy of Dermatology expert
Information presented at the American Academy of Dermatology's Summer Academy Meeting by Amber Reck Atwater, MD, FAAD, a board-certified dermatologist and assistant professor and director of the Contact Dermatitis and Patch Testing Center at Duke Department of Dermatology in Durham, N.C.

Common symptoms of facial allergic contact dermatitis
The most common forms of facial allergic contact dermatitis include:

Eyelid dermatitis
•Redness, scaly skin or itching appears 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
•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 that 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

Lip dermatitis
•Scaly skin or itchiness occurs directly on the lips or around the lip area
•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

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

Mobile phones and facial rashes: Is there a connection?
A rash that appears on the cheek and in front of an ear on one side of the face may indicate an allergic reaction from nickel or chromium found in certain models of mobile phones. Dr. Atwater noted that many of the reported cases of mobile phone nickel-induced facial dermatitis have occurred in flip phones, and the newer smart phones may be less likely to contain these substances on the outside. However, she added that there has been one reported case of an allergic reaction occurring from a smart phone case or cover that contained silicone.

When a mobile phone is suspected as the source of an allergic reaction, a dermatologist can test a patient's phone to determine if it contains nickel. It is important for patients to find out what it is about the phone that is causing a rash and then replace that part or the entire phone.

Doing a little detective work and treatment options
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 may conduct patch testing to try to identify the source of the allergy. Patch testing involves exposing the skin to chemicals that commonly cause allergies to see if one of them causes a reaction on the skin.

Once the allergen is identified, the appropriate treatment can be determined. For a mild reaction, patients might find an over-the-counter hydrocortisone 1% cream or ointment is helpful. A dermatologist may prescribe a topical steroid for more serious cases, though treatment with a topical steroid is dependent on the area of the face being treated, since steroid use can result in harmful side effects. Dr. Atwater added that other non-steroid creams also can be used successfully on a case-by-case basis.

Patients should expect to see an improvement two weeks after avoiding the allergen. In some cases, it could take up to eight weeks before the symptoms clear completely.

American Academy of Dermatology expert advice:
"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."