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.
What If The Rash Is In Your Diet
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
A rash after you eat something feels simple, but skin allergy rarely is. We sit down with board-certified dermatologist and Mohs surgeon Dr. Carsten Hamann to break down systemic contact dermatitis, a lesser-known form of allergic contact dermatitis where reactions can be triggered not just by skin contact, but sometimes by ingestion. We unpack how this differs from true food allergy, why eczema and allergy can look identical, and why nickel—found in both products and foods—is such a common and surprising culprit.
We also cover other rare triggers like cobalt, chromium, and fragrance components like Balsam of Peru, plus how certain foods and dyes can mimic or worsen reactions. If you’re stuck wondering “eczema or allergy?” the takeaway is practical: seek patch testing, take a detailed exposure history, and test changes intentionally instead of guessing.
Patch Test Clue For Nickel
SPEAKER_02If you're worried about a nickel allergy, like you mentioned, you can do a patch test to see if they're allergic to nickel. You know, there are some studies that just say or you know show that if you ask the question, have you ever had problems with jewelry before? You know, lots of skin diseases can get worse with certain diets. You know, we know acne gets worse for most people with kind of high whey protein diets. We know a lot of most people with rosacea have clear dietary triggers like alcohol or spicy food.
SPEAKER_03People also maybe misunderstand or maybe always think that the necessary step is what is the role of the dermatologist in this versus an allergist?
SPEAKER_02Like I said, I I really trust patients when they say their skin disease gets worse with a certain type of diet. I think we don't know, we don't necessarily understand um, you know, every interaction between diet and the skin.
Show Setup And Guest Introduction
SPEAKER_00Welcome 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_03Welcome to the Dermot Trotter, Don't Swear About Skin Care podcast. On today's show, I've got Dr. Carson Heyman. He's a board-certified dermatologist, Mo's micrographic surgeon, who serves as director of clinical research and staff dermatologist at Sawaro Dermatology Associates in Phoenix, Arizona. And he loves itchy skin and things you're allergic to. So welcome to the podcast, Carson. Yeah, happy to be here. So since you love itchy things and things that make the skin itch, I wanted to talk more about things that we actually might eat or consume that make our skin rash or itch. Because I think there's a lot of misconceptions out there about, oh, you know, if I get a rash, it definitely has to be linked to something I'm eating. That's the first thing everyone tends to think about. So I wanted to have you kind of on today's show, clear the air about something we call systematic contact dermatitis, what that really is, and talk more about things we ingest that might cause rash.
SPEAKER_02Yeah, so a big part of my practice is what's called patch testing or how we diagnose skin allergy or what's also called allergic contact dermatitis. And there is a form of allergic contact dermatitis called systemic contact dermatitis, where you actually develop a rash, sometimes a whole body rash, sometimes in certain areas, after you ingest something that you're allergic to. Now, like you said, uh a lot of people have some misconceptions about allergy in general and on allergy to things that you that you consume. It's quite confusing because um in in dermatology and in medicine, we use the word allergy to describe more than one type of thing. Um properly speaking, there's actually four types of allergy: type one, type two, type three, type four. Now, type one allergy is also called immediate type. That's where um you come in contact with something and you immediately have like a like a swelling or anaphylaxis. So the prototypical thing would be I'm allergic to penicillin or I'm allergic to peanuts or you know other kind of um food proteins. And someone who's allergic to peanuts, as soon as they you know swallow a peanut or quick quickly after they touch peanuts, they have this immediate reaction. Um, now, confusingly, there's another type of allergy, what's called type 4 allergy, and that's more what I was describing before: allergy in the skin. Most classically, this shows up as reticy rashes in the area that you're exposed to. Now, in those settings where people have a skin allergy to something, a question that often comes up is well, what happens if I'm exposed to this via food? And um, it's pretty rare, but some people who are allergic to things on their skin um can develop a whole body rash or rashes in certain parts of their bodies after expo after oral exposure to those.
Nickel In Food And Low Nickel Diet
SPEAKER_03That's kind of fascinating. So something I put on my skin or comes in contact with my skin that creates a rash there. There could be a food drink, something I consume that basically has the same, you know, ingredient, if you will, or you know, type of thing in it that could create a rash on my skin. So I think the one that maybe some people know about, and I find this fascinating because for some reason I think we forget that minerals and metals are actually in foods, right? I think we think about it as more of a process thing that surrounds us that, you know, yes, it's on that periodic table of charts, but it exists in nature. It's not something I'm necessarily putting into my body. And the big culprit I have to mention first is nickel, because I'm definitely allergic to nickel earrings. I get that nice kind of wet, itchy rash, looks like poison ivy on my earlobes. If I were potentially allergic to nickel, if I ate something with nickel in it, what would happen to me, my skin?
SPEAKER_02Yeah, so um, nickel is the most common skin allergy in the US. About uh 20% of women are allergic to nickel, and that is tied really closely to the amount of piercings you've had. Now, by far and away, most people who are allergic to nickel are really only going to have trouble with nickel contact with the skin. Um, but like we've discussed, there is this phenomenon where oral ingestion of nickel can cause either whole body rash or sometimes a rash woman on the hands. Sometimes you can get a reactivation of the spot that you were patch tested to that diagnosed you with skin out with nickel allergy. Now, again, this is not very common. I see this maybe five, 10 times a year. Um, but in the setting of a person who has uh an allergy to nickel, if they have a whole body rash that's not responding to normal treatment, sometimes we pursue something called a low nickel diet. Um, unfortunately, it seems like all the best foods have nickel in them, like green leafy vegetables and like wine and beans and chocolate. Um, so the I really wouldn't wish the low nickel diet on anyone. Um, but in those rare cases where a patient's rash is that severe or where you know they really, you know, the the avoiding nickel contacting their skin hasn't resulted in improvement of their symptoms, then that's sometimes sometimes something that we pursue.
SPEAKER_03So the real key feature then you're talking about there is if somebody happens to have a nickel allergy and, like you said, more diffuse all over body rash, and say maybe their dermatologist thought, well, I thought it was eczema, right? I thought it was eczema atopic dermatitis more specifically, and they gave them a medication to treat it, even if it was a systemic one. Would would that actually help if they were truly allergic to nickel and got that systemic rash, or would it not improve it at all and make you more suspicious that that could be a reason why they're still breaking out?
SPEAKER_02Yeah, I mean, I think I think that's a great question. Often just normal eczema and systemic allergy to something like nickel could could mimic each other, and it can be difficult to kind of maybe suss out which one, which one, which kind of category you're in. I think as you clued into if you do an appropriate treatment for eczema and it doesn't improve, that's really a time to reflect on are we kind of broken up the wrong tree here? So sometimes we do see people who, you know, they have kind of diffuse rash and they have kind of diffuse itchiness, which certainly could be eczema. They get started on an eczema treatment and they don't improve. And in those scenarios, certainly if they're allergic to nickel, something like a trial of a nickel-free diet would would be very reasonable. And and um, you know, it can be frustrating patient to it can be frustrating for patients and for providers because there's not just like a straight blood test that tells you, oh, is this eczema or is this skin allergy? You know, even if you biopsy skin allergy, it can look like eczema under the microscope. So figuring out what's what is a lot more a lot more trial and error, a lot more, you know, for example, trying an eczema treatment and seeing if it gets better. Trying a nickel-free diet, seeing it gets better. Um, one of our mutual mentors, Dr. Zyris, he always says, you never know if it's skin allergy until you avoid the allergen and you get better, right? That's kind of like the proofs in the pudding. He probably would argue then you have to re-expose yourself and get worse again. But uh, I try not to do that with my patients.
Dermatologist Versus Allergist Testing Roles
SPEAKER_03So we mentioned obviously it's not that common, but I think a lot of people out there think it's common, right? They they say now they might typically think that it's more something they ate, like, you know, a particular, you know, fruit, like a strawberry or something like that. But for things that actually your skin can be exposed to, I think can be shocking to people to even think, oh my gosh, could I actually ingest that type of thing and get a rash? I I think too, what people also maybe misunderstand or maybe always think that the necessary step is is what is the role of the dermatologist in this versus an allergist? And I think that's something that's not well understood. You know, for the most part, be like, do I need to go see a dermatologist or an allergist? Like who really can sift through the clues here and find out what's going on? What do you say about that?
SPEAKER_02Yeah, I mean, I think it's a natural human desire to kind of get at the root cause of a problem. And it feels like diet should be the root cause for a lot of things. But, you know, what I tell my patients is certainly diet's very important for skin health. It's very difficult to do studies on it, though. So if I have a patient who says, uh, you know, my skin disease, whatever it might be, gets worse when I do, you know, when I have gluten. I totally believe that and I think that's reasonable, but it's hard for me to have a universal recommendation about diet for my patients. You know, lots of skin diseases can get worse with certain diets. You know, we know acne gets worse for most people with kind of high whey protein diets. We know a lot of most people with rosacea have clear dietary triggers like alcohol or spicy food. Um, in the case of kind of this more eczema skin allergy, though, it it's much less common. Um, like I said, if there's a clear kind of tie temporarily between ingestion of something and a rash right away, usually those patients kind of figure it on figure it out themselves. Every time I eat strawberries, you know, I can hardly breathe. Like they don't necessarily need a test to prove that. Um, you know, I really recommend for providers to really empathize with patients and recognize that trying to find kind of the root cause in diet is a natural kind of um desire. But at least in this kind of skin allergy world, it's certainly the exception, not the rule. Now, with regards to kind of which specialty sees this more often, um, you know, we it's kind of split between dermatologists and allergists. Historically speaking, um, that kind of type one allergy, the immediate type, that was kind of run by allergy, and the type four type, the more kind of delayed, um like rashy type was handled by dermatologists. But more and more allergy providers are doing patch testing as well. So a lot of it depends on your kind of not your zip code, but your area, referral patterns, who who primary care sends to. Um, like I said, that's a big part of my practice. So it's something that I kind of wish Derm was hold on to a little bit tighter, but it kind of depends on where on where you're at. Certainly that type one testing, which is actually the prick testing, if if you've heard of if your listeners have heard of that, um, that's really almost done exclusively by allergy. And then again, this kind of patch testing, eczema, is shared.
SPEAKER_03Well, and nickel, you mentioned being the most common contact allergen. You know, some other ones that maybe aren't as well known. I just wanted you to help our audience understand some other things you could potentially ingest and what they're found in and other products that could produce a similar rash to you know a systemic nickel allergy. What about like cobalt, chromium? I mean, these are things people like again. I remember that in chemistry on the periodic chart, but where in the world would I put that on my skin? And now potentially how could I be ingesting something like that to create a rash?
SPEAKER_02Yeah, I think if I asked my patients like how much cobalt do you eat, they'd, you know, I'm crazy. Is that a beer or a wine?
SPEAKER_03Because I can't, it kind of has a feel.
SPEAKER_02Yeah. So I mean, when talking about systemic contact allergy, nickel would be the number one culprit. Again, very rare, but you know, we do see this sometimes. I think number two would probably be cobalt. Um the only setting that I've seen it in is in really high um B vitamin products. And so you see case reports of you know, the teenager who's drinking 10 energy drinks a day and they're getting, you know, even in one of these like monster energy type drinks, you know, there's 40,000 times the amount of B12 you need. And so if if you're really pounding those and you're allergic to cobalt, there have been some cases, and I've had a couple where I think it's relevant in that exposure. Um, chromium is even even kind of rarer. I'm not sure if I've ever seen it, and it's almost always in the context of supplements. So someone doing, you know, some again, patients want to get to the root cause of things, and some patients think that supplements are really the way to go for that. But if you can just take supplemental chromium, like in a pill, and if you're allergic to chromium, it might cause problems. Um, one of the other kind of dietary exposures that I do sometimes see in my clinic is people who are allergic to balsam of Peru. Balsam of Peru is kind of a natural occurring fragrance marker, um, you know, derived from a tree in the in the Brazilian rainforest, but it's both used in the fragrance in fragrance industry and it's used as a marker for people who are allergic to fragrance. So we we test to it um to see if maybe you're allergic to fragrance. And um some patients who are allergic to balsam of Peru, again, in that same setting where they have a rash that um kind of on their whole body or that's not really in areas where they're coming to contact with fragrance and they're not responding to appropriate like normal treatment. I I will sometimes kind of query their diet and see if they're eating a lot of high balsam food foods. High balsam foods are like citrus, tomatoes are often a big one, um, like vanilla type scented products, um, Coca-Cola is another thing. So dark sodas. Um, this is like right here.
SPEAKER_03You're not helping me.
SPEAKER_02So again, I mean this is like a once-a-year type thing for me. Yeah, and um but but but certainly it's reasonable to consider that in in those types of patients.
SPEAKER_03Well, I think one go ahead.
SPEAKER_02I was gonna say one difficult thing for for patients is is uh you know, how do you choose the diet, right? I mean, I guess you can Google like high balsam foods, but it it can be quite difficult. Uh what I recommend the most for the nickel diet is there's actually an app now that's pretty good about tracking your your food and you can you know try to keep let's it's almost like uh Jenny Craig kind of thing, like there's points, there's like nickel points, and so you like keep your points down. You can save them up so you can have uh green leafy vegetables for dinner or whatnot. Um, but in the setting of where my patients are maybe worried about nickel um exposure and with a nickel positive and a rash that's not getting better, I recommend doing that for like six weeks and seeing if they improve. Um, unfortunately, there's not an app for the balsam-approved diet, but typically the only time I've actually seen true balsam systemic allergy is in the context of like super high balsam foods. So someone who says, Yeah, I eat 20 tomatoes a day. You know, it's usually outside the realm of kind of a normal diet. Um, and so often you can kind of just get it based off of history. Or yeah, I drink, I don't know, 20 Diet Cokes a day, something like that. Maybe maybe no settings, you say maybe just cut back on the soda and we'll see if your rash gets better. But yeah, there's there's a little bit of a uh absence of lots of really good patient-directed um information out there.
SPEAKER_03Well, and and I know we keep emphasized this isn't common, but I think people will find it just interesting, you know, that it's even like the possibility because a lot of people hear fragrance, they may not know balsamapuro, you know, specifically, and think, gosh, I didn't I didn't think of fragrance and things I'm actually eating. Because I think people tend to separate that out, not realizing a lot of our fragrances come from naturally derived products. And then people make the connection, like, oh, that totally makes sense. Like I don't know why, you know, it didn't dawn on me, you know, in the first place. And I think it's hard for people to make that connection, like, oh, I could have used something with fragrance on my skin that then could like sensitize me if I ingest it, you know, to actually get that rash, you know, all over the place. Question I have for you, when we think about this being from a systemic standpoint, when people get exposed then to one of these allergens, you know, obviously you mentioned nickels, same thing. Do for the few cases you do see, that people recognize that history that they were getting a rash to maybe something topically that had one of those ingredients actually in it, and then kind of help you lead to the diagnosis. So is it a known thing, or are you automatically patch test them to look for it?
SPEAKER_02Yeah, I I think uh again, some of that depends on referral patterns. So I get a lot of people refer to me for patch testing. So we're kind of already down that that road a little bit. But but often, you know, patients, there's not a really close temporal relationship between exposure to something ingestion like this, like a nickel diet, for example, and a rash. And so it's it can be difficult for patients and clinicians to really kind of find that causal link because again, it's it's not like an immediate, I touched a strawberry and my lips swelled, right? Um so no, often it it takes a little bit more kind of investigation. Now, you know, it if you're worried about a nickel allergy, like you mentioned, you can do a patch test to see if they're allergic to nickel. You know, there are some studies that just say or you know show that if you ask the question, have you ever had problems with jewelry before? That's almost like a good surrogate marker for nickel allergy. And so, you know, in a pinch, you could kind of rely on that. But you know, I I try to get as much information as possible. So if you're if if you're in a setting where patch testing is available, I think it's worthwhile to kind of check that box and see what shows up. Um, so yeah, again, it kind of depends.
Dye Allergy And Why It Mimics Systemic
SPEAKER_03So we've kind of hit on nickel, cobalt, chromium, balls and brew fragrance. The one I want to talk about, because I think it's been a hot topic, is dyes. You know, dyes have gotten a lot of attention, you know, you know, recently in the media with removal, you know, of dyes, you know, potentially from the market and potentially are they harmful. So it's kind of shifted that movement. Uh do you often see, you know, a relationship where people have a dye allergy and then potentially they're consuming dyes? And where are they getting the dyes from? Because I think people forget about, although it's gotten more attention now, about the dyes we have in our food.
SPEAKER_02Yeah. I mean, the most common dye allergy in, you know, in America and certainly my clinic is a type of dye called dispersed blue dyes, which is our a group of blue dyes, obviously. Now, you know, these red dyes and orange dyes that are used in some foods, some of them can cause a skin allergy. It's not the most fun answer, but it from my standpoint, I've never actually seen kind of an oral ingestion causing a flare of dermatitis. Now, that being said, I think it's you know, certainly it's possible. And I think you know, having an open mind to these things is important. And I think, you know, as a medical community, we continue to learn new things. You know, that that vitamin B12 cobalt interaction, someone figured out, you know, 10 years ago. It wasn't, it's it's not wasn't in the textbook, you know, 20 years ago. So, you know, I think keeping our our our minds open to these possible new interactions is is important, but I don't think that there's any good cases, or maybe maybe you can educate me uh of true like systemic dye related. Now, one kind of uh somewhat confusing thing about dyes is often the rash they can't cause could be your whole body, right? If you're allergic to dyes and clothes, it might kind of almost like a mimic a systemic contact dermatitis. So, you know, the classic distribution for a dispersed blue dye mix would or dispersed blue dye allergy would be kind of diffusely on the trunk, which could be the same in in a systemic contact dermatitis um setting. But in that setting, it'd really be from exposure on the skin, not the GI tract.
SPEAKER_03And it so people that are kind of freaked out, because I I did have a patient that had a dispersed dye blue allergy blue dye allergy, and she was kind of freaked out because she loved her energy drinks that had some of the blue. She said that can I even drink these? Am I gonna break out in a rash? So how would you alleviate that concern? Just say it's highly unlikely, or you know, do you feel like if if that was a source, it would be something to take into consideration?
SPEAKER_02I mean, I I would say I don't know. I mean, I you know, I have I work in in Mesa, which is one of the suburbs of Phoenix, and I have like a lot of honeywell engineers and a lot of people who really want to figure things out. And I think doing uh, you know, drinks, five of them, and see if you're worse that week, and then don't do anything for a month and see if you're worse better the next month. I think doing an experiment is certainly reasonable. Like I said, there's for diet-related questions from patients, it can be hard because the literature is not very robust. I can't point to a a study saying, you know, this diet's better for this or not. Often it's difficult to study, but I think kind of empowering patients to to kind of try to figure it out themselves and be really, you know, no one's gonna get worse by being really careful about what they're eating, right? And so um, like I said, I I really trust patients when they say their skin disease gets worse with a certain type of diet. I think we don't know, we don't necessarily understand um, you know, every interaction between diet and the skin. That's actually a way that the nickel diet often comes up in my clinic. It's the patients who, you know, maybe they get 50% better and they just really want to get to the bottom of it and they they're willing to go through the hassle of something like the nickel diet because that's kind of the kind of person they are. They're you know, really kind of detective like people themselves. And so they're willing to put put up with it to try to you know figure out how to get that next 50% better. And I and I think a lot of those patients find a lot of success. And, you know, if they don't, you move on to the next kind of diagnostic algorithm.
Aspartame Formaldehyde And Food Pathways
SPEAKER_03Now we already talked about kind of balls and brew, other culprits, you know, thinking about my soda here. What about artificial sweeteners as I'm enjoying this diet coke here? Have you seen where you think people truly have, you know, a systemic, you know, rash related to artificial sweetener? Because I see it written about. Uh, not that I know that I've seen it can use, but a lot of you know thoughts about it.
SPEAKER_02Well, you know, I'll be honest, I don't think I've I don't think I've seen a true like aspartame systemic contact allergy. Now the two kind of reflections on that is um aspartame apparently does break down to formaldehyde, and formaldehyde is another common allergen. And so there have been a couple cases of people um with high kind of aspartame diets who are allergic to formaldehyde whose whose skin gets worse. Often it's in the context of eczema, like their eczema gets worse. Um so that's been described again, not something I've seen. And then I think the other thing to recognize is you know, when we're talking about systemic contact allergy, we're talking about a very kind of specific type of immune response to an allergen or to a chemical. But you know, there's other problems you can have with diet that aren't a strict contact allergy, right? So someone who's allergic to, you know, has a gluten sensitivity, it's not because they have a systemic contact allergy to gluten. It's a it's a different, you know, they're missing an enzyme that helps them break down the gluten proteins. So, you know, when people tell me that they have certain symptoms from diet or that, again, certain skin diseases get worse with certain diets, uh I think that's often very true, but it doesn't actually fit into that very kind of strict criteria of a systemic contact dermatitis. So I think a lot of the people who have had problems with aspartame, it it's probably a different pathway. It's probably not a true kind of systemic allergy. But um, yeah, I think we're learning more and I and I certainly I think that's possible. I feel like those patients tend to show up more in like primary care office. Usually there's more um you know vague symptoms like bloating or like you know malaise or you know you know drowsiness or mind fog. Um they tend not to come to the skin doctor quite as often, but um it's possible. I don't know. Have you seen that before?
SPEAKER_03No, that's why I was always curious because I obviously know artificial sweeteners are not good for you in general, and I'm probably consuming them more than I do.
SPEAKER_02I think you have an ulterior motive.
Supplements Heavy Metals And Propolis
SPEAKER_03So I'm hoping you're telling me this isn't common. So it makes me feel better about finishing that diet coke later. But I I think why one thing that people are thinking about, because it's so popular now, are all the vitamins and supplements that I know we touched upon this just briefly earlier. But do you think there's some truth to that or being cautious about, you know, and again, you might want to distinguish here. I think people wonder am I truly having a drug hypersensitivity reaction versus, you know, systemic contact term? How does that even look different? Or is it consideration where they're along the same spectrum? Like, how do you look at those two being distinguished? Because I think that's where people always worry they're taking these medications. Of course, they think it's natural, so they think it's okay. You know, that couldn't be the reason that I potentially have a rash.
SPEAKER_02Yeah, I mean, I think supplements certainly play a role in in health in general, but you know, in contrast to some of the medications we use, there's a little bit less of a rigorous QI, like making sure that it is what it is, and a little bit less rigorous um, you know, stability data. Like if you have a supplement that's 10 years old, is it gonna be the same? Who knows? And so, you know, if patients are interested in kind of more holistic health and are interested in in supplements, I the first thing I say is make sure you're getting it from a you know reputable source. Um and then there are some you know guidelines online. There's an integrative dermatology group that publishes you know some helpful guides. And I think sometimes people might go overboard and you can't overdose on some of these things. And like I mentioned with like just chromium, if you take a lot of chromium pills, you can get a get a rash. And so, you know, everything in moderation maybe, but certainly in the context of systemic allergy, if you're allergic to cobalt and you're taking vitamin B12, that'll that can make you itchy. You know, there's some evidence that just vitamin B12 in general, even if you're not cobalt allergic, can cause some itch, especially in the elderly population. So again, I think some of these supplements might have other effect on the skin and potentially potentially causing rash or potentially causing um itchiness. But in terms of the straight contact allergy, it's usually the heavy metals like cobalt chromium in the settings we've discussed. Um, the other thing I've seen a few times is propolis. So propolis is a natural ingredient in beeswax containing products. It's it's it's um it's the food that the worker bees feed the queen, uh, and it's gonna be all in all these beeswax-containing products. But in some cultures, they um isolate it and they use it kind of for for uh as a supplement for health. And um, you know, twice I've seen one of them was a spray that was used for like uh sore throats. And she was hospitalized and she was doing it in the hospital and was still having trouble in the hospital. And the patient, the hospital team thought she was kind of in in um like septic and like super sick. And then the other one is in pills. So you can buy this over the counter on Amazon and in those settings. And I don't know that much about how good it is for your health, but I know certainly if you're allergic to propolis, you probably shouldn't be ingesting um ingesting it.
SPEAKER_03Well, I was just thinking that kind of brought up another good point when you were mentioning that. I was just thinking about you know, people that might drink teas, different teas, just because of the exposure that they're potentially getting with all the different, you know, plant materials or things from the composite family or like chamomale tea that the people actually have had. I and I did have a patient come in and it was diagnosed elsewhere, but she said, here's the deal. It was so funny. I was drinking this tea, and of course she'd been exposed to other plants in that family. And she's like, I've always rashed like to plants in that family. And she's like, and then I couldn't believe I avoided those, but I was drinking tea, you know. And I'm like, oh my gosh. I just thought that was fascinating. I don't know how common again that is, but I don't know if you've ever seen cases like that where it's linked to, I mean, I think teas open up a whole another bag of worms just because of all the different combinations and possible things people could get exposed to.
SPEAKER_02Yeah, absolutely. Um, you know, straight allergy to tea is not something I see that often, but I think it's probably something I don't ask enough about, right? Yes. Um, you know, the most common skin allergy to a plant is probably just poison ivy. That's kind of like the most prototypical skin allergy. It's so common that we don't actually even test to it. It's usually pretty straightforward, right? The patient comes in from the from camping and says I got into poison oak or whatever. Um but outside of that, it's like you mentioned this composite family. So that's a flowering um, you know, genus that includes things like um I was gonna say composite, but obviously um chamomile, like fever few, um uh like um daisies, that that type of thing. Arnica. And so things like arnica, fever few, these are sometimes used in traditional like Chinese medicine or in kind of more holistic things and in things like teas or in things like supplements. Um and so sometimes it certainly is relevant. I I think in my experience, it's been a little bit more relevant for like intraoral problems, so like lip dermatitis or you know, nonspecific gingivit, like you know, corrosive gingivitis, that type of thing. Um but certainly if you patch test someone and they're allergic to the composite family, and there's a couple different things we test to I I evaluate that. I think asking about you know traditional medicine interventions and asking about tea is is uh kind of a no-brainer.
SPEAKER_03I think that's so fascinating because even as a dermatologist practicing for a while, those are things that sometimes they they get forgotten, right? It's just not on your radar that you even think about that patients could be potentially doing, even if you identify or know they've had a historic relationship with that allergen. I think that's a connection sometimes, again, like you said, although not common, you know, just to have it there in the back of our minds, because we tend to see the uncommon in dermatology.
SPEAKER_02So as we kind of wrap up, it's one-finded, right? So I do wonder, like I said, maybe some of these things are more common than we think. And we just I think like you know, patient preferences and patient activities also change over time. So I think the use of things like you know, um, you know, traditional type medicines, like even topical Arnica and topical fever feel, these are things that I think are are more common today than they were, you know, even five, ten years ago.
What To Do Next And Patch Testing
SPEAKER_03Yeah, I mean with actinic purpose, I mean I rec recommend Arnica-based products all the time, you know, to try to help with resolution. So I mean, just things that you know that we recommend even that we use on a daily basis, because I I do have an older patient population, so that's a very common complaint. And I start to think, gosh, am I, you know, have I ever had somebody come back that I don't really appreciate, maybe there's a relationship. So it's gonna be on my radar for now. You definitely have helped kind of make me more aware and think about that. Where before I think it was definitely in the back of my mind. So if, you know, if a patient or used suspect systemic contact derm, you know, I think just as we wrap up here, you know, what should they do? And again, treatment, how was this approached? If you can kind of sum that up.
SPEAKER_02Yeah, I mean, I obviously I'm a little bit biased, but I think if you're worried that you have a systemic contact allergy, you should probably try to find a dermatologist or someone who who or an allergist who patch tests, I guess. But I think dermatology is kind of uniquely equipped to differentiate these different things. You know, like like we mentioned, you know, differentiating systemic contact allergy from just normal eczema or it is is not always simple. And I think finding someone who's you know, a board-certified dermatologist who's experienced at kind of differentiating these skin diseases is the way to go. And hopefully that includes a patch test at some point. You know, access to patch testing isn't isn't isn't always really easy, but um, you know, when you can get an answer from a simple procedure like a patch test, I think it's it's it's worth your while.
SPEAKER_03Great advice. And I think you definitely have to be a little bit of an investigator, thorough, thorough history. I have patients write down kind of every and anything. So it's amazing what sometimes becomes relevant that nobody was really even thinking of. I think that's what's fascinating about contact derm in general. It's sort of, you know, just the process of getting to the answer and where it leads you from there. I think that's kind of the exciting part of the subspecialty of dermatology.
SPEAKER_02That's why I like it.
SPEAKER_03Those are blessed to have people like you, Carson, making this your career. Well, thank you so much for coming on the podcast. I appreciate you spending some time with us here today. I I think this will really educate people out there about, again, how uncommon, you know, systemic contact term truly is, but what they maybe should be thinking of and also for the provider as well.
SPEAKER_02Well, thanks for having me.
SPEAKER_03Of course. And stay tuned for the next episode of Dermotrotter Don't Swear About Skin Care.
SPEAKER_00Thanks 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.
