Derm-it Trotter! Don't Swear About Skincare.
Feeling frustrated or overwhelmed with everything skin? Does the skinformation overload make you want to swear about skincare? Join Dr. Shannon C. Trotter, board certified dermatologist, as she talks with fellow dermatologists and colleagues in skincare to help separate fact from fiction and simplify the world of skin. After listening, you won’t swear about skincare anymore!
Derm-it Trotter! Don't Swear About Skincare.
Unmasking the Mystery of Contact Dermatitis
Contact dermatitis affects up to 20% of people and can appear as either irritant (like a chemical burn) or allergic (an immune response after years of safe use). Unlike typical allergies, it doesn’t improve with antihistamines, making patch testing the key to diagnosis.
Common culprits include nickel, preservatives, and even “natural” ingredients. Dr. Dathan Heyman shares cases—from plants to kitty litter—that highlight how hidden allergens trigger rashes, and how identifying them can bring lasting relief.
You buy a new product and like maybe a new face wash, a lot of people, if they're doing that twice a day, they start to get sort of dryness, redness, peeling, inflammation. And that's because it's an allergy from a different branch of the immune system. It's not release of histamines that cause the swelling.
SPEAKER_01:So a positive reaction, you're kind of looking for like swelling or redness or maybe even like blister formation type thing. Is that kind of what you're looking for as a result?
SPEAKER_02:Yeah, I mean, in its most crude form, you're looking to see that the reaction kind of matches the symptoms you're working up.
SPEAKER_00:Welcome to Dermot Trotter, Don't Swear About Skin Care, where host Dr. Shannon C. Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skincare experts to separate fact from fiction and simplify skincare. Let's get started.
SPEAKER_01:Welcome to the Dermitrotter Don't Swear About Skin Care podcast. On today's episode, we have Dr. Dathan Heyman, a board-certified dermatologist and the medical director for Contact Dermatitis Institute and the Associate Program Director for Honor Health Dermatology Residency in Scottsdale, Arizona. Welcome to the podcast, Dathan.
SPEAKER_02:Thank you so much for having me. I'm I'm excited for for this afternoon.
SPEAKER_01:Well, it it's a good topic to cover. We're going to talk about something called contact dermatitis. And some of our listeners out there might be like, I don't even know what that is, which is why I wanted to bring you on because I do think it's something that people just don't understand the concept of it and different types and how you treat it or go about working it up. So I'm going to pass the baton to you right away and see if you could just give us kind of a global overview of what is contact dermatitis.
SPEAKER_02:It's a great question. Contact dermatitis is a common and morbid skin disease in the United States. So throughout your lifetime, most studies show that between 10 and 20% of everyone will have contact dermatitis at a particular time. Dermatitis means inflammation of the skin, and contact implies that the reason for the inflammation is something from the environment. And so the most common reason to have contact dermatitis would be from something that's irritating. So something like a soap or water or an acid, almost like a really subtle chemical burn over time causes this nasty eczema-like rash. Those of us who specialize in contact dermatitis are also very excited about the allergic type of contact dermatitis, where you can develop an itchy rash from something like poison ivy in an acute setting. But when it's something that you expose yourself to over time, like your cosmetics, your hair products, you can actually get a very long-standing eczema-like reaction that is sometimes hard to recognize as a form of skin allergy. And so identifying and diagnosing those problems are the key to many patients having healthy skin over time.
SPEAKER_01:So kind of look at those two groups. You have the irritant contact dermatitis, and then you have that allergic contact dermatitis. I think most people walking into our offices, you probably would agree with this, like immediately think, oh, I gotta be allergic to something. But is that really true? Like, what are the majority of cases really looking like for these patients?
SPEAKER_02:Well, there's a definitely a uh a referral bias because by the time someone shows up at my clinic, they tend not to have a straightforward case. So when you look at the most classic cases, um, it doesn't even take a doctor to figure some of it out. When you buy a new product and like maybe a new face wash and you start using it, let's say it's a benzyl peroxide face wash because you you're struggling with acne. A lot of people, if they're doing that twice a day, they start to get sort of dryness, redness, peeling, inflammation, and that can evolve into an eczema-like reaction. That would be an example of an irritant contact dermatitis. But a lot of patients, they're intuitive enough that, hey, this really started right when I bought that new product. So believe it or not, patients are sort of too smart for that to be a common clinical problem in my practice.
SPEAKER_00:Okay.
SPEAKER_02:So I tend to get much sneakier things like um allergy to maybe a treatment that they've used for a long time. So, for example, we occasionally will have patients that have um like dandruff, and their dandruff shampoo worked very well for many years, but then something changes in their immune system and they start to develop inflammation because of one of the active ingredients, like they've developed a new allergy. And they've they're tricked because they have used it safely for so long. And some that's the type of patient that generally requires an allergy test to make that diagnosis. Same thing with irritant reactions. One of the most common reasons for irritant contact dermatitis in my clinic is just soap and water. And so you get someone who's very intuitive and smart and experienced, even someone in healthcare, like take a surgeon or a surgical tech or a dental hygienist, and they live and breathe healthcare and they wash their hands safely for many, many years. But it's that cumulative disruption of barrier function that over time starts to let those irritants in. And it's not even an allergy, you know, but the absorption through damaged skin of irritants over time slowly increases that inflammation, and you can get a super nasty rash from things that don't intuitively feel like they're all that irritating, you know? So those are examples of um the types of cases where you know the diagnosis is a little bit less straightforward.
SPEAKER_01:Yeah, it that's something you know interesting that you commented on like how you know you can use something over time or something you've used for years and still develop an allergy. So I think a lot of patients are shocked by that. You know, they always want to look for that new product, or if they had a reaction to a medication, you know, if we think it's medication related, it always has to be a new medication. But as you highlight, it's not necessarily the case. So can you explain kind of what happens over time in the skin? Because people always say, but I've used it for years. Well, all of a sudden now, you know, would I develop an allergy related to it? And you alluded to it a little bit earlier, with just kind of that breakdown of the barrier, but do you mind explaining that a little bit more?
SPEAKER_02:Sure. So allergic contact dermatitis is a form of skin allergy. And in the general public, when people say that they have allergies, generally what they mean is either a drug allergy or a food allergy or something to the external environment. That might be dogs, cats, you know, pollen, stuff like that, dust mite. And we generally consider those to be what we call immediate or histamine-mediated allergy. And it's a little bit nerdy, so I don't want to get too in detail, but that's why when you have seasonal allergies and you can take an antihistamine, you feel a lot better. People that start to get allergic eczema, they they might have some improvement in their itching when they take an antihistamine, but they rarely notice significant clinical improvement in the in the actual inflammation. And that's because it's an allergy from a different branch of the immune system. It's not release of histamines that cause the swelling, it's actually lymphocytes that have a clonal expansion or a proliferation of these immune cells that the cells themselves are specifically targeting an allergen. And what we typically say is that you have an increased chance of developing that allergy with increased exposure. So interestingly, you seem to be more alert, more uh the chances of you developing an allergy actually goes up the longer you use something, not goes down, which again is a little bit, which is a little bit counterintuitive. I we could I talk with my residents that if you're like in an ER or an urgent care and you think it's contact dermatitis, usually it is the right question to say, well, what have you changed recently? But if you're sort of a contact dermatitis expert or someone has really chronic skin disease, then that's the wrong question. But whether or not that's the right or wrong question, it has some, it almost has more to do with the context. Because again, by the time someone shows up at my clinic, none of the intuitive answers have worked. So it's either not contact germ or it's unintuitive.
SPEAKER_01:Yeah, and I think that'll people find that fascinating because in general, you know, everyone assumes it's the new thing. But you know, like you mentioned, the longer you're used to it, the greater the exposure, the more likely you are to develop an allergy. And I think that's really gonna shift a lot of listeners' mindsets out there and think twice about maybe something they could be potentially allergic to. So if somebody comes to you and they suspect, you know, an allergic contact dermatitis, how do you work that up? You know, people might have heard of this patch testing before, but what exactly is that and how does that help you identify what they might be allergic to?
SPEAKER_02:So patch testing is the gold standard uh test for diagnosis of allergic contact dermatitis. And it's the same philosophy of testing as with sort of standard environmental allergy testing. We're going to take the common causes and we're going to take small amounts of them and apply them to the skin in a controlled, in um controlled way and then see how your immune system responds. When you do environmental testing, generally you either do blood tests or prick tests where you apply them to the skin and then you poke them and see if they hive up. And because it's an immediate reaction, you generally can get results in 15 to 20 minutes. But this is a delayed reaction, and so it can take between you know three and seven days for the reaction to come up. So we actually don't use any needles, we just put the chemicals on stickers and they're applied generally to the patient's back, and then they're removed generally at 48 hours, and then it's at that sort of five-day sort of final read where we are assessing the skin for inflammation that mimics sort of that um that allergic sort of eczema reaction.
SPEAKER_01:So a positive reaction, you're kind of looking for like swelling or redness or maybe even like blister formation type thing. Is that kind of what you're looking for as a result?
SPEAKER_02:Yeah, I mean, in its most crude form, you're looking to see that the reaction kind of matches the symptoms you're working up. And there is a standardized grading criteria that we use called the International Research Group grading criteria. Um and the criteria include redness, swelling, the presence of vesicles or little blisters, or the confluence of different um, like the joining of small blisters to make larger blisters.
SPEAKER_01:And for I would say for those patients, then if they get a positive, say you're looking at their back and you read some of those chemicals as being positive, does that mean that it's really relevant to the rash that they're presenting? Or sometimes you just find positives that really don't mean much for the rash itself?
SPEAKER_02:So that's a really, really good question that we talk about a lot in my clinic. So contact allergy is the immunologic state of being able to react to something or having the cell population that's allergen-specific. Contact dermatitis, allergic contact dermatitis is the clinical disease manifestation. So it this is not a genetic problem, but think of it almost like having a mutation that puts you at risk for a cancer syndrome or something like that. Like having contact allergy puts you, gives you the ability to have this clinical disease. And so you can have a dermatitis and have it not be allergic. That's irritant dermatitis or others. Um you can also have contact allergy without disease. So when we see that someone has a positive reaction, that confirms that they have a contact allergy, but it may or may not be related to the skin symptoms for which they were referred. So that's why when we get a positive reaction, we have to take a step back and try to assess if we think that that is relevant. And generally the way that we do that is by looking at the patient's exposures. So in my clinic, we ask every patient to bring all their products in to their read day, and then we'll look through them together. So today was a read day in my clinic, and we have um had a bunch of really cool cases today. So one of them was a woman who had rash off and on for over 20 years, and she had been patch tested um many years ago, but she didn't remember the results. And she was allergic to composite. So she had um an allergy to a group of sort of botanical uh the composite family, which is like the chrysanthemum family. And there's a bunch of invasive species here in Arizona now that um expose people unknowingly to this type of allergen. And not only does it cause a bad allergic conduct dermatitis, it can be spread not from the pollen and the protein itself, but the dust and the particles of the plant can be spread through the air. And so it can set up on the face and be really nasty and cause a bad rash. And also it can become almost like a semi-permanent type of allergy with prolonged exposure to sunlight. So she had chronic allergic contact dermatitis airborne, and she had chronic actinic dermatitis. So these are the different sorts of clinical um uh phenotypes that are all related to contact allergy. So we had to assess about that relevance. And the answer is I think given her environment, it is relevant. But she also reacted to tixacordol, which is a marker for steroid allergy, which is in many cases what the textbook recommends as first-line treatment for different types of eczema. So she was she has a stubborn problem with sort of more than one phenotype, and she's also allergic to what essentially her previous doctors the textbook said was the right treatment for her. So those were both completely relevant. Now, in the next room, we had a woman who we patch tested, and she had a really exuberant facial eruption and um also with myositis, and she has uh we ordered blood tests on the day that we did her patch um consult. And today she had reactions to several things, including caramine, which is like a red dye, and a few other things, and yet her um ANA came back like a huge high titer. And in the context of dry eye, myalgia, arthralgia, sun sensitivity, facial eruption, and no known exposures to her contact allergens, you know, you could say, well, you this contact allergy is real because you were referred here and we did this testing, and your body is reacting to this allergen, but that isn't really the best explanation for the symptoms that are bothering you the most. And of course, I think she has an evolving connective tissue disease. So um taking the patch test results and doing the interpretation in the context of the of the exposures and the symptoms, I think is is is can be really challenging, but it's really rewarding.
SPEAKER_01:Now, for that case, um you mentioned like the arthralgia. Do you mind going back and explaining kind of those symptoms a little bit? Because it we kind of went through arthralgia, myalgia, just or yeah. Sorry, I know for the patient piece. Am I just going through the second case for me again?
SPEAKER_02:Yeah, sure. So um connective tissue disease or autoimmune diseases, are notoriously tricky to diagnose, especially early on. So when you look at, for example, a disease like lupus, the criteria to diagnose that for many patients relies on a multitude of factors. And skin plays a big role for many patients. But you may also note that certain types of blood tests, including low platelets, low white blood cell count, these sort of screening tests for umtigens that are produced that target the cell's nucleus or things inside the nucleus, um, along with other clinical features are important. And some of the other clinical features would be sun sensitivity, joint pain is the sorry, the arthralgia is sort of a medical term that describes joint pain, uh, muscle pain, other evidence of end organ damage or inflammation. And so you when you take those types of symptoms and put them together, um even in the face of a positive patch test, you you know, you might say, I think we have enough evidence to push us in a slightly different diagnostic direction. Is that clear? Is that enough clarification?
SPEAKER_01:Yeah, I was just trying to get with some of the definitions for people. So again, with you know, with people just listening, I was just having you kind of explain that a little different, you know, from the outrage, because people might be like, arthralgia, what's arthralgia? Like, so that's where I was just having to explain it, like joint pain, muscle pain, sensitivity, the constellation. So that's good. That's a whole bit.
SPEAKER_02:To make it slightly more basic, I guess I would say a lot of times dermatologists, we think, is this like an inside out rash? Is this inflammation coming from the inside or is it kind of coming from the outside? Um, for for those of you who who aren't as familiar with that, the more in sort of internal symptoms you get, the more suspicious we get that maybe it's an internal inflammation and joint pains and fevers and swollen lymph nodes and and blood tests being abnormal sort of help support that.
SPEAKER_01:And then you know, we talked about, you know, in those two cases. What I love is the first one. You're you're mentioning, you know, one of everyone's favorite plants in the fall, you know, looking at chrysanthemums or mums or composite that comes from that. I think what's important to really just highlight from that case, too, is kind of this concept that natural products might always be better for people. And I think people forget, you know, we do see a lot of allergic reactions to things that come from plants or botanicals, as you mentioned, and nothing more classic, right, than poison ivy for an allergic contact dermatitis that we see in a lot of patients. So great takeaway for people to kind of think about, because that's a very common trend nowadays, right? People are looking for these more natural or plant-derived alternatives that they want to put on their skin, not even thinking, oh my gosh, I could potentially be allergic to something like that. And then the second case, like you said, it may not even be allergic contact dermatitis at all. Maybe they have something else going on, but by the time they get to a specialist like yourself, you're able to sort of tease through that and help make that diagnosis. And for the allergens, then we know we talked about the composite. Like what else do you see that are common allergens that people might even have in their household, might even know that they could be potentially be allergic to that might surprise them that you often find on patch testing?
SPEAKER_02:That's a great question. Um many of the things that cause allergic contact dermatitis are very common in daily life. So poison ivy is the most famous. Some people don't realize that it's we consider it in medicine to be a form of allergy because it feels so toxic, but it is an immunologic sort of allergic reaction. Within the house, um jewelry and hair dye are probably the most common. Um jewelry, people know that cheap jewelry uh might break them out, and that's true. Nickel is the most common cause of that. And nickel can be found in toys and electronics and coins and keys and belts and glasses and watches and all sorts of stuff. Within jewelry, certainly cheaper jewelry is more likely to release a lot of nickel, but you can't outspend nickel because it's not only used because it's cheap, it's used for durability and for shininess. And so a lot of white gold may not be a good choice for someone who's allergic to nickel. So you so again, it's not necessarily a high price, isn't a surrogate marker for safety for those types of patients. And there's a small test that you can buy to assess for the release of nickel because some alloys may even have a little bit, like some stainless steel has some nickel in it, and it's still considered safe because it doesn't release all that much. And it's really the interaction of a nickel ion with the immune cell that produces the inflammation. Other things would be dermatologists love to say that we don't really recommend um neosporin or neomycin or topical antibiotic products. And there's a bunch of reasons for that. The most obvious is that in studies, it doesn't seem to prevent uh infections when used on clean wounds. So, for example, after a skin biopsy, it doesn't typically offer patients any benefit. But on the flip side, it does uh uh it is not an infrequent cause of allergic contact dermatitis. So um I would say in our clinic, if you add together um all sort of treatment associated contact dermatitis, it's probably 20 to 30 percent of our patients. So today I mentioned that we had a steroid allergy, I take secordal allergy. Um, neomycin is not an uncommon one either. We haven't had one in a few weeks, but it's a it's among our probably top 10 to 15 allergens. Another one today that's a little bit less common, but but still important is the propylene glycol, which is found in a lot of hypoallergenic products. So we had a woman who had that allergy who was here today as well. So topical medicaments are actually a fairly common cause as well. The other list of things I like to rattle off would be things that make creams creamy, things that make soap soapy, so shampoo, conditioner, um, cosmetics are common, fragrance chemicals are extremely common. What else? Rubber, leather, fabric, dye, nail polish, all sorts of stuff like that. So it's it's the stuff coming from within the house.
SPEAKER_01:And then you're probably scaring people now as they're looking around their bathrooms and everything else. And then work-wise, do you see a lot of people you know that work in certain industries that wind up coming to your office that you suspect to contact dermatitis? Or there's certain allergens there that you kind of usually are thinking top on your list if somebody has a particular job or profession that they might develop an allergy to something that they're coming into contact with work.
SPEAKER_02:That's a great question. So occupational contact allergy is um uh just a wonderful, amazing topic. It's notable that most um skin dermatoses aren't allergic in the workplace, but it's it's probably the most it can be a very sort of long-standing, morbid uh and and preventable um disease. So it's a very, very important occupational disease. The um the data isn't repeated very often, but in many surveys, it's the most common occupational um or among the most common occupational diseases in America. And I distinguish that from occupational injury, um, but it is a common and a and a costly problem. Imagine working and putting yourself through school to be a dental hygienist or to do something within healthcare, only to find that it's too hard to keep your skin healthy and then you have to retrain and start at the bottom of a job ladder in a different field. So it's it affects patients quite a bit. The classic professions that seem to have higher risk would be people that work with their hands, for example. So that's people who work in healthcare, in food prep, in hospitality, in custodial work, in um yeah, construction. Hairdressers are really common or at a significant increased risk for hand eczema, things like that. And so screening those patients specifically to extra allergens that account for their unique exposures often is an important part of their workup. So, for example, the people that work with fiberglass are just exposed to a lot of interesting chemicals that can cause allergy that the average patient isn't exposed to. And so that's one of the reasons that when we meet with patients to decide what they need to be tested to, we look into not only their sort of their home exposures and to the exposures of the people that live in in the house with them, like pets and um spouses and kids, but also their workplace. So I'd say in my clinic, gloves uh and rubber allergies specifically are probably the most common occupational contact dermatitis. But um, but yeah, it's a it's a beautiful and interesting field.
SPEAKER_01:I love how you say beautiful. There are people out there just thinking, man, this guy loves contact dermatitis. Which you do. We all know. We all know. So we've kind of walked our way through like, you know, different types, irritant, allergic contact derm, really focus a little bit more on that, allergic contact derm, how that looks for workup, who might be more prone to develop it, especially in the workplace, and also all the things at home that might be the cause. Now that maybe you've had somebody come through, you've suspected allergic contact derm, you've done the patch testing, you identify the cause or the trigger for it, what's the treatment? Like what do you tell somebody to do next? Because that's going to be the toughest part.
SPEAKER_02:That's a great question. So classically, the treatment is avoidance. So you the diagnosis is in a way the treatment. So let's say you are allergic to a rubber accelerator. We need to get you into a glove that doesn't have that chemical. And in many cases, a substantial portion of patients will see good clinical response. And so it's it's really powerful to be able to just with that diagnostic information, counsel a patient, and then many patients may be clear long-term without the need for medication or drugs. Some of our more complicated patients, they have an allergy because they have other skin problems. And then it's not quite so straightforward. Or in cases where it's challenging to avoid the allergen, or in cases where they have many allergens to avoid and it's challenging to do all of it at once, then it's a little bit more tricky. So in those cases, many of the other treatments we use for eczema or inflammation can play an adjunctive role. And the chronic actinic term that I mentioned earlier is a great example. If you are working in an environment where that plant occupies um several hundred acres uh of natural land adjacent to where you work or where you live, then allergen avoidance is not so easy. And so we have several patients who they have strong, like really significant seasonal flares of this allergic eczema related to those types of plants. And some of them have required systemic immunomodulation or anti-inflammatory treatments in order to stay clear. So, I mean, obviously the kind of the heart of contact allergic contact neurmatitis and patch testing is that avoidance can be such a powerful treatment strategy. But otherwise, you have to sort of take things into consideration where the patient's at and go from there.
SPEAKER_01:And I, you know, with the avoidance piece, I can imagine it can be, you know, simply stated, like as you said, but really compliance to be able to just adhere to that has got to be tough for patients to really kind of follow through. And some of those medications that you mentioned, what what are some of those medications? I know, again, probably you know, talking about offly will use, of course, but what are some of those medications that you might actually use to help a patient that has allergic contact dermatitis that just doesn't respond completely to an avoidance, or maybe there's something else brewing as well?
SPEAKER_02:Yeah, so that's a great question. It's very sort of patient-specific. Um one thing that I'll tell I'll kind of describe to patients is like contact allergy development of it is uh probably associated with barrier dysfunction. So we used to believe that people with genetic or atopic eczema probably didn't get allergic contact dermatitis, but there's good evidence now that they're probably just at at as high of risk. Well, they there's probably no protective factor of their sort of TH2 skew against the development of contact allergy, which is sort of a fancy way of saying that their genetic eczema probably doesn't protect them from developing new allergies in adulthood. And so they can get them. And their skin is already sort of more fragile and more leaky, and that can increase their risk for developing new allergies. But the reason that they came in is that we were suspicious that maybe allergy was why they had eczema. So there's this interesting sort of chicken and egg dynamic here. Do you have skin allergy because you have sensitive skin, or do you have sensitive skin because you have contact allergy? And the answer in a lot of cases is it's just one or the other, but sometimes it's both. And so when a patient, I know they have like very convincing positive reactions, and I say, you need to avoid this hair dye product or this hairspray product or this shampoo or whatever it is, and they come back and they're not better, or maybe they're only half better, then the first thing I do is ask them to bring their products in. And that's because of something called cross-reactors. So contact allergy is this clonal or expanded, proliferated population of cells that target a specific allergen. The problem is the way that our bodies interact with chemicals is that super, super chemically similar but slightly different chemicals occasionally can activate those same cells. And we see that a lot with stuff like hair dye and fabric dye. They're not exactly the same chemical, but geez, they're very close chemically. And so some patients essentially have like a double allergy. We call it cross-reactivity, where the same cells are excitable by slightly different chemicals. And so when patients don't respond when they avoid allergens, I bring them back and I say, hey, are there any cross-reactors that you're exposed to? Or are there any other exposures we haven't thought about yet? So a classic example uh of just an exposure that isn't accounted for would be other people living in the home. So when I was a resident uh at Nationwide Children's, we had this girl who like kept getting rash on the arm, and she we patch tested her, she was alerted to a preservative, which she promised wasn't in her products after we counseled her. And of course, she was right, but it was her cat that was sitting in the kitty litter that has to have preservatives to prevent spoilage, and then sitting on her after. So that's what we call transfer, you know, dermatitis. So assessing for allergen avoidance isn't very straightforward. And so when patients aren't better, I love to see them back in the clinic to explore that. In fact, I say that I really like to spend a lot of my clinical time with patients on the read day or after rather than at the beginning, because patients often don't know what they are exposed to. And being able to target your questions to what you think, what you already know they're allergic to is much more powerful after the patch test. So that would be my sort of my first approach. But in the case of that chronic actinic dermatitis or other chronic allergy, contact allergy where it's hard to avoid, the use of off label like IL4 inhibitors or um JAC inhibitors can, in some cases, be really important for patients. Historically, chronic actinic derm is managed with things that are very challenging to get, like thalidomide or things that may not be good options for older folks, you know, things like methotrexate or other things. And we do explore some of those. But um, you know, it's a case by case. You have to look at their other uh health problems and all that.
SPEAKER_01:Well, this has been pretty amazing to have you go through this story of contact dermatitis because I know there's people out there like, I didn't even know this was a form of rash that it could even exist. And I think a lot of people don't realize how complex it is. I think what you gave is a great illustration of kind of beginning to end. And the workup is just the beginning, right? The hard work comes with the avoidance piece. And then what an investigator, like you really need to be like, you know, really good at a mystery, I think, for contact dermatitis. Because like you just gave that example with the kitty litter. Who would have thought it, right? Like the patient believes they're doing everything right, you think they're doing everything right, but at the same time, the patient, you know, is actually having, you know, challenges that, you know, are linked to the cat of all things, right? It goes back to the cat. So I think it's just kind of amazing to hear that whole story. And I really appreciate you coming on, just giving everyone a little taste of what is contact dermatitis. I know we've educated some people out there about this concept in dermatology. And this course a lot more that we can talk about it, but at least we know that there's treatment even beyond the avoidance if patients do suffer with it. So there is hope to get better control. Uh so data, for our patients and listeners out there, the people that want to come find you, where can they find you online or where would you have them look you up to get more information about you?
SPEAKER_02:Yeah, for sure. Um in Arizona, I'm in a private practice and uh academic sort of hybrid hybrid setting, and my practice is called Soraro Dermatology. SOARO is S-A-G-U-A-R-O, which is our state cactus state flower, which is very fun. Um, but for colleagues, uh most of the work that I do is through the Contact Dermatitis Institute, which is sort of an educational um entity that publishes our lovely contact derm textbook and puts on a uh yearly patch test meeting. And you can find us on like LinkedIn. Um so yeah, that's that's where to find me.
SPEAKER_01:Fantastic. Well, thank you again for coming on the podcast. We really appreciate all your insights that you provided today. And for those of you listening out there, stay tuned for the next episode of Dermot Trotter Don't Swear About Skin Care.
SPEAKER_00:Thanks for listening to Dermot Trotter. For more about skincare, visit dermittrotter.com. Don't forget to subscribe, leave a review, and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.
