Walter Liszewski, MD, and Kara Mudd, PA-C, join together for a discussion , Contact Dermatitis Conundrums: A Panel Discussion on Challenging Cases at the Grand Hyatt Deer Valley in Park City, Utah, at the 2nd Annual Elevate-Derm Alliance Summer Conference.

In this video

Working through a series of clinic cases, Mudd and Liszewski push back on the idea that "natural is not always better" — natural products can be just as allergic, if not more so, than synthetic ones. She flags fragrances, essential oils (linalool, limonene) and tea tree oil as common culprits and reminds clinicians to look beyond direct contact to airborne sources like the essential-oil diffuser running in a young patient's classroom. Their framing throughout is that patch testing isn't about telling patients they can "never do x again," but finding safe substitutes: dip nails or plain polish for acrylate-allergic patients, and a hair dye without PPD (or a semi-permanent dye) for those who react to permanent color.

For healthcare workers with hand dermatitis, both recommend patch testing right away, since constant hand washing and irritant exposure disrupt the barrier and let allergens penetrate. When an allergen or irritant can't be avoided, Liszewski layers in hand phototherapy, non-steroidals to spare the skin from long-term steroid thinning, and in some cases oral or biologic treatment. The conversation closes on carmine — a "natural" red dye found in cosmetics, lip balms, and food additives that patients often adopt to replace red dye #40, with notable cross-reactivity.

  • "Natural is not always better" — natural products, especially fragrances, essential oils (linalool, limonene), and tea tree oil, can be as allergic as synthetics; look for external sources like classroom oil diffusers.
  • Patch testing is about finding safe substitutes, not banning the activity — acrylate/gel nail allergy cross-reacts ("if you find Tabasco spicy, you'll find sriracha spicy"), so steer patients to dip nails or plain polish.
  • Patch test healthcare workers with hand dermatitis right away — frequent washing and irritant contact cause barrier disruption and high rates of allergic contact dermatitis.
  • Manage unavoidable hand dermatitis with hand phototherapy, non-steroidals (to avoid long-term steroid skin thinning), and oral or biologic agents in select cases.
  • For PPD hair dye allergy, extended patch testing helps — about half aren't allergic to toluene-2,5-diamine sulfate and can use non-PPD dyes, and semi-permanent dyes are an option for those allergic to both.
  • Carmine is a "natural" red allergen in makeup, lip balms, and food/protein-powder additives, with cross-reactivity to watch for.