Current Commonalities in Contact Dermatitis with Matthew Zirwas, MD

At the Maui Derm NP+PA Fall meeting in Nashville, Matthew Zirwas, MD, a board-certified dermatologist based at DOCS Dermatology in Columbus, Ohio, presented on contact dermatitis, atopic dermatitis, and recent literature.

After his presentation on contact dermatitis, he spoke with Dermatology Times about the disease state, including diagnostic challenges and upcoming therapeutics.

Sulfites in Contact Dermatitis

Zirwas started the conversation by focusing on sulfites, which he declared the “Allergen of the Year.” He clarified that sulfites are unrelated to sulfates, and are commonly found in systemic contact dermatitis.Sulfites can be found in wine, cured meats, and maraschino cherries, and Zirwas said avoiding them can help alleviate symptoms.

He noted that online resources, such as low sulfite diets, are available to help manage sulfite allergies. “The other thing that's just interesting about sulfites that a lot of people don't know about: If you're somebody who gets headaches from drinking wine, it is because of the sulfites,” Zirwas said. “If you go online, you can find things that will remove the sulfites from the wine, and then you won't get headaches from wine anymore.”

Dietary Nickel Allergy

Next, Zirwas discussed the overlooked and misdiagnosed dietary nickel allergy, affecting 1% of the general population. He says that patients with this dietary allergy can have gut inflammation and systemic cytokine release from nickel in their foods, leading to various symptoms like chronic fatigue and arthritis.

“The problem was we didn't have a great way to deal with it,” he said. Recently, Zirwas noted a low nickel diet cookbook was written by Laura Duzett, a dietitian and medical student.He recommended a nickel patch test and a 2-month trial of the low nickel diet for those with suspicious symptoms.

Allergies to Acrylic and Dip Nails

During the pandemic, Zirwas noted an increase in allergies to acrylic and dip nails due to at-home nail kits. “If you see someone who comes in with face, neck, or eyelid dermatitis. Take a look at their nails,” he suggested

Zirwas stated switching to different types of nails (i.e. dip nails swap to acrylic or vice versa) or avoiding new nails for 2 months can help diagnose the allergy.Feminine hygiene pads, which often contain acrylates, can also cause allergic reactions in those sensitive to the chemical.

Persulfate Allergy and Hot Tubs

Interestingly, Zirwas has found persulfate allergy to be more relevant to hot tubs and swimming pools rather than hair bleaches. He said persulfates are used as shock treatments in hot tubs and swimming pools, causing dermatitis in 1% to 2% of people.

Challenges in Diagnosing Contact Dermatitis

A common misunderstanding, Zirwas addressed the misperception that patch testing is necessary for diagnosing contact dermatitis. He encourages clinicians to use their best clinical judgment, with avoiding potential allergens often being sufficient for managing contact dermatitis.

He noted that patch testing should be considered for those with occupational exposure to chemicals. Zirwas recommended hypoallergenic products, such as those from Cleure and VMV hypoallergenics, which he says can be effective in managing contact dermatitis.

Effective Therapies for Contact Dermatitis

To end his discussion with Dermatology Times, Zirwas shared his excitement for JAK inhibitors, which are now available for long-term treatment of contact dermatitis. He says these are especially helpful for those who cannot avoid allergens.

“They can be a challenge, because if you can't legitimately say the patient also has a component of atopic dermatitis, then we're talking about off label use, which means we're not going to be able to cover by insurance,” Zirwas said.

For patients with disease overlap, Zirwas says JAK inhibitors are a great treatment choice.

To explore more of our coverage from Maui Derm NP+PA Fall 2024, click here.