Dear Readers:

I frequently am surprised by what people request or respond to after they read my Massage Today columns. The things I often think will generate a lot of interest or discussion land with a thud (for instance, avian flu and whooping cough), and the topics I think must be old-hat and overdone for massage therapists generate an enormous amount of interest. Such has been the case for my articles on herpes simplex, warts, psoriasis and superficial cysts. So, to keep to the skin diseases trend, I offer the first of a two-part article on dermatitis and eczema: common, confusing, and frequently overlapping conditions that many massage therapists see and deal with on a daily basis.

The terminology around dermatitis and eczema is extremely confusing, largely because there is no universal consensus on what each term really means. If interested readers pursue this topic to get more information, they might be frustrated to find that some resources seem to use the word eczema to be synonymous with atopic dermatitis, while others (including this one) differentiate atopic dermatitis as a subset of eczema. Welcome to the world of pathology research!

In all the reading I have done on these topics, this is how I have ultimately organized the dermatitis/eczema hierarchy. (This is not the only way to organize these concepts, but can be a useful tool to see how these conditions relate to each other.)

Contact Dermatitis

For this discussion, we'll pick the simplest of these skin conditions: contact dermatitis. This is, as the name implies, inflammation of the skin where it has been touched by an allergen or irritating substance. This is different from skin rashes related to reactions that are not from direct skin contact: hives related to stress, or psoriasis, which involves skin cells that reproduce too rapidly.

Contact dermatitis comes in two forms: as a result of irritating or damaging exposures, or from a localized allergic reaction.

• Contact irritant dermatitis: Picture this: In five minutes, your realtor is bringing over a possible buyer for your house and you want it to be perfect. Horrors - there's a ring around your bathtub and your rubber gloves are nowhere to be found. What do you do? You scrub the tub with cleanser, with no protection on your hands. Not surprisingly, your skin gets rough, red and irritated. (But the house looked great and you got a lot more than your asking price, so it was worth it.)

Once in a while, we can afford to damage our skin in this way. It heals fast, after all, and all is well again within a few days. However, if a person submerges their hands in caustic, irritating chemicals, or even just water, over and over again, the skin may sustain longer-term damage: contact irritant dermatitis. It's distinct from contact allergic dermatitis because everyone who scrubs their tub without gloves damages their skin, while not everyone has an allergic reaction to latex or nickel.

• Contact allergic dermatitis: This usually is a type IV delayed hypersensitivity reaction. Nickel is one of the most common skin allergens. People who are allergic to nickel can't wear cheap earrings; they get an itchy rash where their watchband touches them; and they may have a red, flaky circular lesion on their abdomen, right about where the button of their jeans hits. This is contact allergic dermatitis: an allergic reaction only where the allergen touches the skin. Other common skin allergens include latex, and some dyes, soaps, lanolin in wool, adhesives on bandages, and preservatives in lotions. Some massage oils have a high rate of causing reactions on the skin, too: almond oil is particularly allergenic.

One group of allergic contact dermatitis outbreaks is probably familiar to most people: reactions to poison oak, poison sumac and poison ivy. The allergen in these plants is an invisible oil called urushiol, and about 75 percent of the population has a reaction to it. Urushiol is significant because not only can it remain potent even after months on tools or other surfaces, but it also can disperse in the air when plants are burned, leading to allergic reactions on the skin and possibly even in the respiratory passages of people nearby.

Massage for Contact Dermatitis?

If a client has contact dermatitis, it's important to identify what the triggers are and to avoid them in a massage setting. In other words, if this client is allergic to almond oil, it's important to have alternate lubricants available. (Many lotions contain almond oil, so read labels carefully.) But if a client has a red scaly mark where the button on their jeans hits, or around their wrist where their watch lies, this is not a significant issue for massage - we certainly won't catch the condition and we won't spread it (unless we use the watch as a massage tool!).

If a client has contact irritant dermatitis because of exposure to harsh chemicals or other substances, massage with lubricant might speed the healing process. Be aware, however, that massage brings blood to the area, and we want to avoid making itchy spots itchier. Also, we want to be careful about any scratching or blisters that might compromise the shield of the skin to invite infection: these make any kind of contact dermatitis a local contraindication.

For Next Time

In my next column, we will continue this discussion of non-contagious skin rashes with an exploration of eczema. In the meantime, if any pathology issues come up for you and your clients, feel free to let me know: What's on your table?

Many thanks and blessings!