When Our Clothes Cause Contact Dermatitis03/01/2023
PARIS, France — This shirt? That scarf? These sneakers? Excellent Christmas gifts, right? Most of us would say so, not thinking twice about clothes, accessories, or footwear — that is, until we put the item on and notice that our skin doesn’t quite look or feel right. At the Dermatology Days of Paris (JDP 2022) conference, the discussion at a session on allergies to textiles and accessories was enough to make anyone’s skin feel itchy.
Textile Contact Dermatitis
“When the rash matches up with the item the person was wearing, the diagnosis is pretty straightforward,” said Evelyne Collet, MD, a dermatologist at Dijon University Hospital in France. One thinks of the textbook examples: eczema that looks just like a nurse’s new clogs or shows where there once was a metal necklace or a dyed fur collar.
In other cases, however, the diagnosis can be much more involved. So, Collet listed some of the signs of textile contact dermatitis, such as the affected area being right up against the clothing. Sweat and friction can also favor the development of eczema. “Very often, these are the eczemas that are resistant to topical steroids. Keep this in mind when your patient tells you that they don’t understand why their eczema persists despite the treatment,” she advised. It’s also important that patients bring the suspected item for the dermatologist to examine.
Another thing that makes the diagnosis a challenge is that textile contact dermatitis can look like atypical forms of papular eczema, erythema (multiforme-like or prurigo nodularis-like), purpuric dermatosis, nummular eczema, cutaneous pseudolymphoma, erythroderma, or even lichenoid dermatitis.
Test Patient and Item
The European Standard Series is a must when testing for contact eczema, as it contains not only a marker for dyes (textile dye mix), but also markers for metals, preservatives, and rubbers. In fact, if textile dyes are chiefly responsible for the contact dermatitis, other components of the clothes or accessories may be involved, such as the materials themselves and the textile processing and finishing techniques — but also the preservatives and fungicides that must be used, given the long distances between production sites and points of sale.
Applied to textile fibers on clothing, processing and finishing are used to shape the garment, increase wrinkle resistance, and enhance the dye — and even make the fabric feel better to the touch. They can also impart waterproof, mothproof, and antistatic properties.
The metals that cause allergies are mainly nickel, cobalt, and chromium. Nickel is found in metal accessories like belt buckles, and chromium in leather products.
“The European Standard Series may not be sufficient, so other tests will have to be added to it. But above all, the textile in question is going to have to be tested,” explained Collet, who went on to specify the method. “You cut out a piece of the fabric — a square, three quarters of an inch — and wet it. You do a semi-open test. And as with classical tests, you watch what happens after 48 hours, 72 hours, and 96 hours.”
“And for patients whose tests are negative,” she continued, “you have to do a use test. This is the case for 12% to 24% of patients.”
Recommendations for Patients
With respect to dyes, we have guidance from Nadia Raison-Peyron, MD, a dermatologist at Montpellier University Hospital in France. Wash new clothes before putting them on. Read the labels to find out the fiber content. People with allergies should choose natural fibers, such as cotton, flax, and wool. “The OEKO-TEX label certifies that the item doesn’t contain the most allergenic textile dyes.”
As for metals, Florence Tétart, MD, a dermatologist at Rouen University Hospital in France, had the following advice. If you’re allergic to nickel, invest in a patch test. If you’re allergic to chromium, avoid leather products and be cautious when it comes to footwear that claims to be chromium-free. In addition, she recommended that, in terms of primary and secondary prevention, everyone should “opt for European products.”
This article was translated from the Medscape French edition.
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