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When Allergy Gets in the Way of Vanity

Posted Jan 01 2011 2:01am
My Skin Patch Test
(Photos by Weng Bunoan)

The Scare of My Life

My colleagues and closest friends know that I have a death wish at 50 years old. I always tell myself that I will not grow old despite my having the “ageing gene,” if there is such a thing. You see, majority of my relatives reached old age. Worse, I have a 50 percent chance of getting Alzheimer’s. That’s why I don’t want to get old, although I have the smoker’s skin and wrinkles, beer belly and balding hair. At 47, my friends – or should I call them such – say I’m already old. Huh?!?

I’m getting self-conscious with my age that’s why most of the time I think young to the point of being childish even. Hehehe. Adding to my sorrowful miseries is my graying thin hair.

Early last year, I began dyeing my hair black every other month. The first two dyeing experiences boosted my morale, vanity-wise. The third time I dyed my hair in June was a different story. My scalp began to swell and itch. As per advise of a doctor-friend through mobile phone short messaging or text, I took antihistamine twice daily for less than a week and that relieved my condition. But in August, when I went to my barber to dye my hair once more, the swelling and itching came back with full gravity and lasted for more than two weeks. The antihistamines I took were not working anymore.

And then the scare of my life happened! I felt a swollen and tender mass behind my ear down to the neck area which was very painful when touched. “My goodness, I have neck cancer,” I said to myself and I was blaming my years of smoking and nicotine addiction!
I thought it was the right moment to consult a doctor, but which doctor – an oncologist, an ENT (ear, nose, throat) specialist or a dermatologist? I chose the lesser degree of illness, skin disease, and turned to the dermatology department of the Jose R. Reyes Memorial Medical Center (JRRMMC).

“It’s only an itch and not cancer,” I comforted myself. For someone who has a death wish at 50, I was not ready and was so afraid to die.

Aging, Vanity and Allergy

Finally I saw myself consulting with a doctor after almost a month of unsuccessful self-medication. I told the lady dermatologist of my situation, particularly the swelling behind my ear. She said that I am allergic to hair dyes and that the “mass” behind my ear was swollen lymph nodes.

I was both relieved and surprised. I was happy to find out that it was not neck cancer, but I was also surprised to know that there were lymph nodes behind the ears. I always thought that lymph nodes are only located in the underarms, inguinal area or in the groin, and under the chin. At my age and several years of working in the Department of Health, I’m still learning something!

And now the sad part. The dermatologist told me that I had contact dermatitis and advised me to refrain from using any kind of hair dyes. “Whaaaaat?!?,” I was screaming in silent protest. Then I reasoned that there are hypo-allergenic hair dyes or something. But the doctor who seemed to empathize with me, said that I cannot use all hair dyes, and politely added that gray hairs would still look nice on me, and pointing out to the wisdom that gray hairs symbolized.

“Yeah right, I would look more like a dirty old man than a wise man,” I thought. Then I dreaded people asking for my senior citizen’s card for discounts. Ouch!

The dermatologist was already filling up her prescription pad, when I said again, “Are you really, really sure that I could not use hair dyes anymore?” I saw a faint smile before she said yes. And to end my persistence, I suppose, she recommended a skin allergy patch test for me to find out for myself which substances that I am allergic to. Betting against all odds that her diagnosis was wrong, I readily agreed right then and there.

Skin Patch Testing

Skin testing for allergies is used to identify substances that are causing allergy symptoms. The three main types of skin tests are the scratch test, intradermal test, and the patch test.
In skin prick or scratch test, a small amount of substance is pricked or scratched on the skin with a sterile needle. If the area becomes red, itchy, or swells, the allergy skin test is positive. If there is no reaction, the test is negative. This test is usually used to test for allergies to pollen, mould, pet dander, dust mites, and foods.

In intradermal test, a small amount of substance is injected into the skin. The intradermal test may be done when the skin prick test is negative but the person is still thought to be allergic to that substance. This test is usually used to identify allergies to bee stings and other insect venom, or penicillin.

Then, there is the patch test that I underwent. The substance is placed on a patch and the patch is placed on the skin for up to two days. This test shows whether a person develops contact dermatitis (rash), which is an allergic reaction on the skin due to direct contact with an allergen such as latex, medications, or fragrances.

Before performing the actual test, I went through an extensive interview with a medical staff. I was asked about my work and my work environment. Then, and she made a run through of a list of substances and chemicals that may have caused me allergies in the past. I told her of few incidents where I got allergies: using metal frames in my eyeglasses, wearing locally-made leather strap on my watch, and spraying certain brands of cologne. Other than those items, I was just fine with her list of allergens. Then, she told me to stop taking antihistamines while on a patch test as this could interfere with the results.

The patch testing that was made on me involved a kit of 25 various test substances placed to my skin under adhesive tape. The purpose of the patch test is to help identify which substances may be causing my allergic reaction. It is intended to produce a local allergic reaction on a small area of the back where the diluted chemicals were planted. The chemicals included in the patch test kit are the offenders in approximately 85-90 percent of contact dermatitis, like chemicals present in metals (e.g. nickel), rubber, leather, hair dyes, formaldehyde, lanolin, fragrance, preservative and other additives.

The adhesive tape that was used had small metal cups in which the substances were contained, and this was attached on my back. The patch test remained on my skin for 48 hours, and during this time, I was not supposed to get the tape wet. Therefore, I only took a sponge bath on the upper portion of my body. I should not also get the tape wet by excessive sweating, and so I took a sick leave at work the following day.

After two days, the patch test was removed and an initial reading of the test was performed by the medical staff. A permanent marker was used to mark on my back where the tests were prior to removal, for an additional reading of the results at 72 hours (or on the third day) after the initial placement. This was another day without bathing for me. I was also told not to touch or scratch my back, and to have somebody mark my back again in case the ink was erased in time of my next consultation.

After three days, the final reading came and this was referred to my attending dermatologist. I was not DYING (yet), but the verdict was more of a death sentence to me because I was told that “I’m not DYEING (my hair) anymore!”

What’s My Itch?

There are two types of contact dermatitis: irritant contact dermatitis and allergic contact dermatitis.

Irritant contact dermatitis is more common and results from repeated contact with a substance, such as soap, cosmetics or skin products, including deodorant, that irritates the skin. The exposure produces red, dry itchy patches usually on the hands, fingers and face. Some substances, such as bleach or strong acids, can cause irritant contact dermatitis after just one exposure. These substances typically remove oil and the protective barriers from the skin.

On the other hand, allergic contact dermatitis is caused by a reaction to substances called allergens. The resulting reaction is your body’s response to the sensitive agent. It produces a red rash, bumps and sometimes blisters when severe. Common allergens include rubber, metals such as nickel, costume jewelry, perfume, cosmetics, hair dyes and weeds, including poison ivy. It may take several years for an allergy to develop. Once an allergy has developed to a specific substance, however, it remains for life. Exposure to even a small amount of the allergen will reliably result in skin eruption.

My final diagnosis is “chronic allergic contact dermatitis” and my allergens are paraphenylenediamine (PPD), Nickle, and Quinoline. What are those?

PPD is a chemical found in hair dye that is very frequently used in hair salons and at home. Dyed hair cannot cause an allergy but the dye may do during application. It is also found in skin paints and occasionally in fur and leather dyes. It is also found in printing inks and oils as well as in photocopying powders.

Nickle is found in jewelry, keys, coins, zippers and buckles, pacemakers, batteries and metal eyeglasses. It is released from metals such as alloys or electroplated items. About 10 percent of women and at least 1 percent of men are affected by nickel allergy, and I am one of them. Tough luck.

And quinoline is an oily colorless compound used as a food preservative and in the manufacture of antiseptics, creams, ointments, lotions, and you guessed it, hair dyes.

Aside from giving me the detailed information about sources of my allergen, the dermatologist also advised me to scrupulously avoid any further contact with the allergens. She also said to carefully read ingredients of new products, especially cosmetics.

Finally, I was also told with great conviction now, “NO HAIR DYES!” Yeah right, you want me to look very old,” I said to myself. And then she added, “Use baby soap.” Is that adding insult to injury already?
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