A Vegan Hiker With a Rash Self-Treated With Coconut Oil

Melba Estrella, MD; Ansley Devore; Alan Snyder; Dirk M. Elston, MD

Disclosures

December 28, 2020

The treatment of allergic contact dermatitis requires minimal intervention if the patient presents early on. Most important is removal of the offending allergen. Some shoe manufacturers that refabricate shoes will make new shoes using only polyvinyl acetate glue rather than rubber cements. Often, a topical corticosteroid is prescribed. More severe cases may require oral corticosteroid administration.[1,4]

Resolution typically occurs after the specific allergen is discovered and avoided. It is important to prevent future exposure to the causative agent when choosing footwear. This may be difficult for patients and physicians alike because there is no mandatory material labeling requirement for shoe companies. Many components are made by third-party contractors overseas. Moreover, hypoallergenic shoe substances, such as plastic, wood, and fabric, are not always available or practical. Because many offending agents cannot be identified, a negative patch test does not completely rule out the diagnosis of SACD.[1,4]

If standard patch testing is inconclusive, testing can be performed with portions of the shoe. This patient was asked to bring in her new hiking boots, and patch testing was conducted. Using the patient's own shoes, which had been soaked in water for 15 minutes, a patch test was applied to her back for 72-96 hours. After a corresponding erythematous, edematous, and vesicular reaction was noted at her follow-up visit, the diagnosis of shoe dermatitis was confirmed.

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