Is My Child’s Bandaid Rash an Allergy?

Warts are no fun. But if you ask my daughter, the dermatitis from the bandage is much worse.

Warts are no fun. But if you ask my daughter, the dermatitis from the bandage is much worse.

It’s not just adding insult to injury.  It’s literally adding injury to injury.  Two of my kids, when they need a bandaid to cover a scraped knee or elbow, end up with that painful, red and raised “rash” from the sticky part of the bandage.  Talk about unfair.  And putting bandaids on a bandaid rash obviously isn’t gonna work.

I remember the first time I saw a rash from bandage adhesive.  I was working as an aide in a hospital, and the rash was actually from the white tape we used to secure gauze dressings.  Then I saw it again.  And again.  And again.  When I worked in family practice, I saw similar reactions on adults and children alike to over-the-counter bandaids (not necessarily Bandaid brand) and patients telling me they were allergic to bandaids.

But is that actually the case?

The short answer is no, but if you’re a geek like me, or a skeptic like me, you want to know more.

And I found more.

First of all, there are a myriad of chemicals, a veritable alphabet soup, that make up the sticky stuff that holds bandaids*** in place.  Are these chemicals harmful beyond the local skin irritation?  I was unable to find literature that specifically answered that question.  But there is plenty out there about the irritating irritation from the adhesive.  And here is what I learned.

Case studies abound regarding the frustrating “allergy” to bandage adhesive.  Not surprising…so many of us get that crazy rash.  Well, researchers Widman et al., decided to investigate this annoying problem and designed a well-structured 2008 study to sort out whether this rash is a true “allergy,” aka allergic contact dermatitis (ACD), or another form of dermatitis.  Because when a patient has a true allergy…to a medication, latex or another potential treatment…this means a change in how that person is treated for an ailment.  So distinguishing an allergy from a sensitivity is pretty important.

Here’s what the researchers did.  Simply put, they patch-tested study participants with a special, custom-made tray of bandages, including ones typically used in a medical setting and ones found over-the-counter (including familiar brands Curad, NexCare and a few Johnson and Johnson).  After two, and later seven days, the patches were “read,” or examined, for signs of skin abnormalities.

Here’s what the researchers found.  1)  A rash to the bandages was more likely to occur after seven continual days of exposure and less likely after just two.  2)  No true allergic reactions to the bandages were noted; however, a majority of test subjects experienced something called irritant contact dermatitis (ICD) from items on the test tray.

So how did the researchers decide the rash was not allergic?  It comes down to the appearance of the rash, which was described as “erythematous, excematous plaques” or in lay terms, “red excema-like raised areas,” which speak to an irritative more than an allergic process.  The rash, as they observed, had well-defined borders and a uniform appearance…also attributes of ICD.   Test subjects described the rash as painful with a “burning” sensation rather than itchy…the latter being more closely attributed to an allergic reaction.  But can a bandaid rash still be itchy?  Sure.  Especially when it starts to heal.  Think about how a simple cut or scrape can feel itchy.  The reason it does has to do with the body’s healing mechanism, not an allergy.

So if the bandaid rash is not allergic one, why does it happen?  ICD, as the researchers explain, does occur because of exposure to the adhesive chemicals.  Repeated and/or continued exposure to these inherent irritants causes the skin to breakdown, react and become inflamed.  Skin may also become dehydrated from the bandage adhesive and react.  And whether you subscribe to the “slow” or “fast” strategy to remove bandaids, skin can tear and then…you guessed it…the rash occurs.

How do I treat a bandaid rash?  An over-the-counter hydrocortisone works well for inflammation and its accompanying pain, redness and itching.  Just be sure to use it on intact, unbroken, skin.

So what can I use instead of bandaids?  There are several options, with varying price points:

  1.  Bandages labelled as “hypoallergenic.”  Remember, those still utilize adhesive to stay in place.  Given the mechanisms described above that cause the “rash,” it’s possible ICD will still occur.
  2. Telfa, or nonadhesive gauze, plus a wrap like an ACE bandage (for larger scrapes like road rash, on a limb) or Coban (not as wide so works better on fingers and for smaller wounds).  Both Telfa and Coban can be found over-the-counter…there are additional names for both so consult your pharmacy for help if you can’t find these products.
  3. The simplest option is to use bandaids for a short duration of time, like overnight or for a few hours at a time during the day.  It’s good to keep a wound covered initially to protect it and, as the Widman, et al., study showed, the likelihood of a rash comes after several days of continued bandaid use.  So the risk of rash is less during the time we typically keep wounds covered.

So the good news is that that pesky bandaid rash is not an allergy.  The bad news is that to avoid it the alternatives are less convenient, may still cause a rash, and can be more expensive than that store brand of bandaids.  Shorter duration of bandaid use to decrease the risk of bandaid rash is likely the best and most cost-effective solution.

As always, if a bandaid rash gets worse…redder, swollen, increasingly painful or itchy and/or starts to ooze, seek medical attention as this could mean a new allergy or an infection.

***I’ll use the term “bandaids” as a catch-all for all the bandages we use to cover small wounds, much in the same way we use “kleenex” to mean all types and brands of facial tissues.  I don’t mean to specifically pick on the Bandaid brand.

Want more details from the Widman, et al., study?  Here’s the link to the medscape article:

http://www.medscape.com/viewarticle/572962_4

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