A rash behind the ear like this could easily have been
diagnosed as seborrheic dermatitis. She had a similar rash behind her other
ear. A bit of dandruff and some scale in the eyebrows would have confirmed your
diagnosis. However this lady also had a rash on the volar aspect of both wrists
and on the V of her neck. This distribution is typical of a perfume allergy.
These were the areas where she applied perfume every morning before work. You
can use a perfume for years before suddenly becoming allergic to one of the
ingredients. Perfumes are a mixture of 20 plus different chemicals and these
ingredients are not listed on the box. Hence other perfumes may cause the same
reaction. Perfumes are found everywhere in our environment from toilets to
lifts. Highly sensitive patients can react to these with asthma. If this
patient wants to continue using perfume she should restrict it to putting it on
her clothes not her skin!
