A 38-Year-Old Dog Owner With a Blistering, Itchy Rash

Melba Estrella, MD; Alan Snyder; John Plante; Dirk M. Elston, MD


October 29, 2020

History-taking before patch testing identifies potential allergens to which patients have been exposed that should be included in the test. Once patch testing is completed, additional history-taking helps determine the clinical significance of the findings.[9] Note that some garments are washed with sodium hypochlorite immediately after manufacture, which causes structural changes in some elastics.[12] Because this practice could potentially cloud the clinical picture if the patient denies washing clothes with bleach, a detailed history before patch testing is key in evaluating patients with suspected bleached rubber syndrome.

Mid- or high-potency topical corticosteroids are the mainstay of treatment to relieve the inflammatory signs of contact dermatitis. Although antihistamines may not relieve associated pruritus, they are usually prescribed. If more than 20% of the skin surface is involved, systemic corticosteroids are recommended.[8]

The definitive management of allergic contact dermatitis is the detection and removal of the offending allergen. Nonchlorine bleach is safe to use, but all elasticated clothing that has been previously exposed to chlorine bleach must be discarded. Patients should be followed up by a dermatologist to assess for the recurrence of dermatitis.

This patient was treated with a regimen of high-potency topical corticosteroids that was tapered over several weeks. After 3 months of follow-up, the lesions had cleared, and he had no signs of recurrence at 8 months.


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