Allergic Contact Dermatitis

Allergic contact dermatitis is an inflammation resulting from exposure of the skin to a substance to which the individual is allergic. Irritant contact dermatitis, in contrast, is an irritation of the skin caused by a chemical, in which allergy is not a factor. The number and variety of chemicals that can cause allergic contact dermatitis is vast, ranging from the well-known plants of the poison ivy family to obscure chemicals of which the individual may be totally unaware. This problem is distinct from the problem of irritant contact dermatitis, though the rashes may be very similar in appearance.

Only a very small number of individuals are allergic to most chemicals, while as much as 50 percent of the population is allergic to poison ivy. After exposure to some chemicals (e.g. dinitrochlorobenzene), almost everyone will develop an allergy. Infants, children, and old people are generally less suscep­tible to the development of skin allergies.

After the allergenic substance comes in contact with the skin, the rash usually develops one or two days later. If the individual has never before been exposed to the chemical or to a similar sub­stance, it will take a week or more for him to become allergic to it and develop a rash. This is called the latent or incubation period.

Once an allergy of this type is established it tends to persist for many years. If one area of the skin, no matter how small, becomes allergic to a substance, the skin of the entire body will also be allergic to it.

Exposure to the offending chemical or plant may be brief and casual, but all that is required for a rash to develop is that some of the chemical penetrate the superficial layers of the skin. (This takes only about ten minutes in the case of poison ivy oils.) Many people with allergic contact dermatitis have no idea what caused their rash, because of the brevity of exposure and the delay in the development of the rash. Frequently, they fail to notice or iden­tify the substance at the time of exposure.

In milder cases of allergic contact dermatitis, the rash may consist only of redness, bumps, and mild to moderate itching. Severe cases develop swelling, blisters, oozing and crusts, and severe itching. The rash often appears as a haphazard distribution of streaks and patches, especially with plant allergies. In later stages of the rash, the skin becomes thickened, dry, and scaly; cracking and chapping may occur. The rash of allergic contact dermatitis usually lasts about ten to fifteen days, but may last longer if the dermatitis is severe or secondary infection develops.

A common fallacy is that the rash "spreads" via" the fluid that drains from the blisters. Other areas may develop the dermatitis over a period of several days, but this is caused by varying amounts of the chemical on skin sites that have different degrees of sensitivity. For example, bits of the plant or its sap under the nails can spread the rash. The skin around the eyes and the skin of the neck, groin, and genitalia is the most sensitive, while the scalp, palms, and soles are the most resistant to contact derma­titis, whether irritant or allergic.

PITTED KERATOLYSIS

Pitted keratolysis is a mild bacterial infection of the skin of the soles, the balls of the feet, heels or toes, and is seen most often in young, active individuals. Small crater-like pits appear, initially tiny. These may coalesce to form large, irregularly shaped erosions. The pits are superficial, do not produce bleeding or tenderness, and have a punched-out appearance with neat, distinct borders. The skin of the pits may be discolored and appear dirty, with in­creased sweating and odor sometimes associated.

This condition is not bothersome unless it is severe and may be present, unnoticed, for some time. Pitted keratolysis is caused by footwear that does not allow air to reach the feet, thus keeping the feet damp.

PITTED KERATOLYSIS Treatment and Prevention

Pitted keratolysis can be controlled by eliminating local moisture. Cotton socks, powder and less occlusive shoes are help­ful. Whitfield's Ointment, available without a prescription, can be applied 2 to 3 times daily, to eliminate the infection.

BLACK HEELS (Tennis Heel, Basketball Heel, Talon Noir)

Tennis heel, although harmless and unnecessary to treat, is mentioned because its characteristic brown-to-black discoloration has been mistaken for a malignant mole. This "disease" is caused by shear forces which produce tiny hemorrhages into the skin, and is normally found at the edge of the heel. The hemorrhages account for the distinct dots or irregular patch that is seen, but the condition resolves by itself and is painless.

TENNIS TOE Treatment

Tennis toe is caused by friction between the nail and shoe, and is the result of bleeding under the toenails. When blood is trapped beneath the nail, pressure on nerve endings results, causing a blue­-black discoloration and potentially severe pain. Repeated abrupt stops which force the toenail against the end of the shoe can precipitate bleeding.

TENNIS TOE Treatment

Treatment is unnecessary except to control pain. Hot soaks and rest are helpful, but relief is dramatic when the pressure under the nail is released by draining the blood. This can be done by heating the end of a paper clip until it is red hot, then inserting it through the surface of the nail into the collection of blood. The paper clip melts its way through the nail plate. This procedure is not as pain­ful as it sounds because the clip passes through the nail into the blood-filled space, and neither the nail nor the blood contain nerve endings. The same result may be obtained by drilling a hole through the nail with a hypodermic needle.

TENNIS TOE Prevention

Again, well-fitting shoes and properly trimmed toenails are the best defense against the shearing forces that cause bleeding from the nail bed.

How to Get Rid of WARTS ?

Warts can be found anywhere on the feet and are often con­fused with corns and calluses. Single warts on the soles are usually surrounded by large masses of callus, and may be quite tender. Mosaic warts, often seen on the heels, are large, flat, diffuse warts that do not become very thick. Warts, like corns, interrupt the normal ridges of the skin. The wart itself contains fine capillaries or blood vessels, which appear on the surface as black or dark brown spots, often referred to as "seeds". When the wart is shaved down, these seeds may exude tiny droplets of blood, revealing their origin from blood vessels.

Warts and corns are usually quite tender when direct pressure is applied to them. On the other hand, pain produced by pinching an area from the sides, between thumb and forefinger, indicates the probable presence of a wart.

You should not hesitate to seek the services of a podiatrist, dermatologist, or orthopedic surgeon for the correction of under­ lying structural or functional imbalances, perhaps through well ­designed inserts or orthotics, or surgery to correct stubborn lesions.

It is reasonable to leave warts untreated if they are not painful and not increasing in number or size. Physicians and podiatrists treat warts with surgery, electro-surgery, freezing, strong acids, and other chemicals.

WARTS Prevention:

The importance of shoes that fit properly and the elimination of areas that produce friction has been emphasized.