By Dr. Jeff Daniels EBS Medical Columnist
Sometimes your clothing can make you miserable, and not because it’s out of fashion. A common complaint that we see in the Medical Clinic of Big Sky is patients developing an allergic reaction from their clothing, most often manifested by a rash.
Most people have experienced and can easily recognize the rash of poison ivy, a reaction in the skin called delayed hypersensitivity, which happens when a chemical from that plant gets onto the skin. Human skin is impervious to most substances, but an interaction between the chemical and the T cells of your immune system results in the blistering, oozing, crusting and itching. Sometimes there’s no recollection of contacting the plant, but it can be carried onto you by your favorite pet, or even through the air if it is burned.
The reaction to the poison ivy toxin can be rather extreme, and there are thousands of other chemicals out there that produce a rash upon contact with the skin. In very few cases the rash will look as terrible as poison ivy, though we rarely see blistering and crusting; usually we see red, irritated skin with small bumps, typically with itching or burning.
In many cases the area of skin involved conforms to something physical that has “imprinted” its image on the skin. In other cases, transfer of whatever chemical is involved, either by touch or by sweating, can lead to unusual patterns that might not be recognized as conforming to an article of clothing, a belt buckle or a rubber glove. The skin around the eyes is particularly susceptible to chemicals touching other areas of the body and transferred by hand contact with the face.
One of the most common contact dermatitis culprits that we see comes from clothing with black or dark blue dye. These are dyes that are loosely held on the fabric and easily rubbed off on the skin. One common denominator is sweat, so dark clothing worn against the skin while exercising is going to more easily leach out its chemicals, interact with the immune system and result in a rash.
Other clothing that can induce contact dermatitis include cotton or cotton/polyester blends that use formaldehyde resins to make them wrinkle-resistant; metals used as fasteners or buckles; tanning chemicals in leather; and latex proteins found in rubber.
When a patient comes in to the clinic with a new rash, it’s important to get a complete history: new medications taken, different foods, travel, and exposure to common household chemicals are possible causes. Could exposure on the job be the culprit?
When the appearance of the rash suggests contact from clothing, it sometimes takes repeated and detailed questioning in order to bring out the relationship. In my experience, reactions to dark clothing dyes are much more common than reactions to soap, detergent, shampoo, or even foods, which are what most people initially suspect as the cause.
Treatment involves avoidance of the offending clothing and the use of steroid medications, either topically or systemically. Testing can be done to try to identify the offending agent, so it can at least be avoided in the future. My advice to anyone is to avoid sweating while wearing black or dark blue undergarments.
Dr. Jeff Daniels was the recipient of the 2016 Big Sky Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.