Yes, You Can Be Allergic to Your Underwear: A Dermatologist's Case Study

Can I Be Allergic to My Underwear? A Dermatologist's Investigation

Last month I saw a runner with a curious itchy rash just along his waistline.  He said that it had been there for a while.  He was well dressed in a suit and tie.  When I examined him, he had a red rash along his waistline.  He thought that it was odd that he experienced more itching and that the area was bright red and somewhat blistery on Monday and Tuesday and as the week wore on it would get better.  It was becoming an annoying cycle.  I really had to scratch my head on this one.  I prescribed a topical corticosteroid cream and advised him to return in two weeks.

At his follow up visit I asked him if he wore different underwear on the weekend as compared to during the week.  He mentioned that during the week he wears boxers and that on the weekend he prefers briefs made by a different company.  The diagnosis was made in an instant.  He had an allergic contact dermatitis reaction to something in the elastic band on his briefs.  He described himself as being pretty sedentary during the week while being an avid runner on the weekends.  It is likely that because he was so active during the weekend that profuse sweating could leach anything in the brief’s waistband that he may be sensitive to.  This would account for the fact that he was worse early in the week and improved as the week went on.

Allergic Contact Dermatitis: Common Culprits and Effective Treatments

Allergic Contact Dermatitis is a common problem in dermatology.  The most common reactions we see are to plants such as poison oak.  Another common reaction is to neomycin which is found in Neosporin or Triple antibiotic ointment.  The reaction is indistinguishable from poison oak.  For that reason, we recommend Polysporin, Bacitracin, or Aquaphor instead of Neosporin.  Nickel is the most common metal to cause an allergic contact dermatitis and it is estimated that 18% of people in North America are allergic to nickel.  If you are allergic to nickel your best bet is to avoid nickel.  One of the challenges in patients with nickel dermatitis is how prevalent nickel is.  People most commonly will contact nickel in jewelry such as rings, earrings, and watch backs.  People are usually surprised when I tell them that their “gold” jewelry is causing a nickel allergy.  This is because most jewelry is made of metal alloys or mixtures of metals with nickel added.  If you have a nickel allergy it is important to only purchase nickel free jewelry.

The best way to treat any allergic contact dermatitis is to avoid exposure.  Our runner did well simply by changing underwear brands.  For someone with a flare the treatment is usually with a topical prescription cream containing a corticosteroid.  For severe reactions oral steroids are sometimes needed.   For instant itch relief I recommend Sarna Lotion.  Oral antihistamines can help with itching.  Avoid creams with Benadryl as an ingredient as you can become allergic to Benadryl by applying it to your skin.  If you have a stubborn or severe case of contact dermatitis we are here to help.

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