The type of textile fibres used in clothing can be a cause of allergic dermatitis. This is an inflammation of the skin, ranging from simple localised redness and itchiness to more serious skin lesions. Usually starts in the first years of life, with many babies experiencing sensitive skin. Here we review current knowledge about this allergy and provide suggestions for potential treatments.
Natural vs. synthetic
Textiles used to produce clothes and other household items, such as bedding and curtains, can be natural, synthetic or a mixture of both. Natural products are 100% obtained from either animals (wool and silk) or plants (cotton). Synthetic products were created artificially by man and include nylon, rubber, fibreglass and polyester. For some people, direct contact with wool may be an irritant, but it’s the synthetic fibres that cause the most number of allergies.
Sources of allergies
Sources of textile allergies include not only the different types of fibres, but also any chemical additives, such as fabric dyes and formaldehyde; and fasteners, such as metal buttons and zips. These allergies are usually localised and more predominant in areas of friction and perspiration. Furthermore, although not technically allergy to the fabric, some people experience similar conditions if their clothes are constantly stained with allergic contaminants.
List of allergens includes:
• Synthetic fibres
• Chemical additives
• Dyes – Disperse blue 106 and 124 are the most common to cause allergic reactions
• Elastic (if in contact with skin such as underwear)
• Flame-retardant materials
• Chemicals used in shoes, including dyes and glue, chromium and formaldehyde tanning agents
Formaldehyde resins: One of the most common complaints is against formaldehyde or the resins used in conjunction with this substance. These are very popular in many different garments to ensure the fabric is less prone to wrinkles.
Fabric dyes: More common than even an allergy to the textile fabrics themselves, is an allergy to a chemical dye that has been added to the fabric to give it a particular colour. There are many reports of allergic reaction to dyes, in particular to those that are loosely held in the fabric and therefore easily passed on to the skin, including azo and anthraquinone.
Flame-retardant materials: This is a rare occurrence, but there are reports of patients being allergic to the chemicals added in flame-retardant clothes. The specific chemical was identified as Tris (2,3-dibromopropyl) phosphate (13) and 2,3- dibromocresylglycidyl ether and resulted in a more generalised reaction due to contact all over the body.
Nickel: This is commonly seen as a rash to buttons or zips, or any other metal decoration, used in clothes. Possibly the most common one is to buttons in jeans.
Contaminants: A wide range of particles lodged in the clothes can cause localised skin allergic reactions, including oil, grease, tar and creosote. These commonly cause folliculitis (inflammation in the hair follicles) and are very common in mechanics and roofers. Other strong chemicals, such as pesticides and solvents, can cause severe generalised dermatitis or even burns.
The most common result of fabric allergies is allergic dermatitis. This condition appears up to a few hours after exposure, and most common symptoms include:
• Skin redness
• Itchy and swollen skin
• In more severe reaction, skin blisters or lesions may form
• Dry and cracked skin
• Long term exposure results in thick, scaly and leathery skin
How is allergic dermatitis diagnosed?
This condition needs a proper assessment and diagnosis because irritant dermatitis can also be caused by exposure to fabric and reveal the same symptoms, but would not respond to the same treatments as the trigger is not the same for both conditions. Therefore, it’s essential for the doctor to be able to distinguish between the two.
Patients with suspected allergic dermatitis undergo a patch test to identify the allergens responsible for their condition. During this test, small amounts of each allergen are applied to the back to see which ones evoke a reaction.
What fabrics to wear?
If you’re allergic to textile fibres or any additives present in different fabrics, it’s essential that you know what products are free form these allergens and therefore safe for you to wear. If you’re allergic to synthetic fibres, your doctor may recommend that you opt for natural products, in particular cotton. The only problem with cotton is that is prone to bacterial infestation, so regular washes are essential. For adults, silk is another option as it helps maintain the body temperature and reduces sweating. However, some people are allergic to sericin, the main protein constituent in silk. A recently developed material based on silk – Dermasilk – is now becoming very popular for adults and children alike. This product is free from sericin and is coated with a microbial agent, with visible benefits for those suffering from allergic dermatitis.
What treatments are available for allergic dermatitis?
Treatment for this condition is two-fold:
• Avoid any contact with allergen: To be able to do this, you need to know the exact allergen that triggers your condition so a correct diagnosis is imperative. Particularly, if at work you cannot avoid exposure, using a barrier cream or gloves may be the best option. It’s important to be aware that it may not be just clothes to avoid, but everything where the allergen may be present. For example, a patient allergic to nickel needs to avoid not only any clothes with nickel buttons, but also some nickel-rich foods, such as tomatoes and chocolate.
• Clear the skin: Various creams and moisturisers are available to be applied throughout the day until the condition disappears. Antihistamines can be used to relieve itchy skin.
You may think that because it results in a localised reaction, allergic dermatitis is easy to diagnose. However, it can be impossible to identify the exact allergen until a patch test is performed, because there are so many possibilities. This may not be a life-threatening condition, but it makes life for those suffering from allergic dermatitis very difficult with the need to constantly being aware of what gets in contact with their skin. With the trend nowadays of moving away from using natural fibres in clothes, it can be extremely difficult to find suitable clothes. The best option is to always wear cotton-based clothes that tend to have less formaldehyde and dyes.
Abrams, K, Hogan, DJ and Maibach, HI. Pesticide-related dermatoses in agricultural workers. Occupational Medicine: State of the Art Reviews 1991; 6: 463-489.
Andersen, KE. Sensitivity to a flame-retardant, Tris (2,3-dibromopropyl) phosphate (Firemaster LVT 23 P). Contact Dermatitis 1977; 3: 297-300.
Caliskaner Z, Kartal O, Baysan A, Yesillik S, Demirel F, Gulec M, Sener O. A case of textile dermatitis due to disperse blue on the surgical wound. Hum Exp Toxicol. 2012 Jan;31(1):101-3.
Dooms-Goosens, A. Textile dye dermatitis. Contact Dermatitis 1992; 27: 321-323.
Fowler, Jr, JF, Skinner, SM, Belsito, DV. Allergic contact dermatitis from formaldehyde resins in permanent press clothing: an underdiagnosed cause of generalized dermatitis. J Am Acad Dermatol. 1992; 27: 962-968.
Garcia Bracamonte, B, Ortiz de Frutos, FJ, Diez, LI. Occupational allergic contact dermatitis due to formaldehyde and textile finish resins. Contact Dermatitis 1995; 33: 139-140.
Hatch, KL, Maibach, HI. Textile dermatitis: an update. (I). Resins, additives and fibers. Contact Dermatitis 1995; 32: 319-326.
Hatch, KL, Maibach, HI. Textile dye dermatitis. J Am Acad Dermatol. 1995; 32: 631-639.
Hatch, KL, Maibach, HI. Textile fiber dermatitis. Contact Dermatitis 1985; 12: 1-11.
Mason R. Fabrics for atopic dermatitis. J Fam Health Care. 2008;18(2):63-5.
Pratt, M, Taraska, V. Disperse blue dyes 106 and 124 are common causes of textile dermatitis and should serve as screening allergens for this condition. Am J Contact Dermatitis 2000; 11: 30-41.
Ricci G, Patrizi A, Bellini F, Medri M. Use of textiles in atopic dermatitis: care of atopic dermatitis. Curr Probl Dermatol. 2006;33:127-43.
Scheman, AJ, Carroll, PA, Brown, KH, Osburn, AH. Formaldehyde-related textile allergy: an update. Contact Dermatitis 1998; 38: 332-336.
Soni. BP, Sheretz, EF. Contact dermatitis in the textile industry: a review of 72 patients. Am J Contact Dermatitis 1996; 7: 226-230.