Last week, Kai Trump, the 18-year-old granddaughter of President Donald Trump, shared a candid moment from her Masters Tournament trip, at Augusta National, which many people with sensitive skin will immediately recognize. While getting ready one evening, she used a hotel hand soap to remove her makeup and woke up with itchy bumps on her neck. The reaction was significant enough that she needed a steroid shot to bring it under control.
“I have very sensitive skin. It was so, so scary,” she told her followers.
What Kai experienced was allergic contact dermatitis. And her story raises a question we hear from patients all the time at NY Allergy & Sinus Centers: how do you find out exactly what triggered the reaction, so you can avoid it going forward?
The answer is patch testing, and it is one of the most underutilized tools in allergy medicine.
What Is Allergic Contact Dermatitis?
Allergic contact dermatitis (ACD) is a delayed immune response triggered when your skin comes into contact with a substance it has become sensitized to. Unlike a true IgE-mediated allergy, which can cause hives or anaphylaxis within minutes, ACD typically develops 24 to 72 hours after exposure. That delay is part of what makes it so tricky to identify on your own. You may not connect the rash on your neck to the soap you used two days earlier.
Common triggers found in everyday products include fragrances, preservatives like methylisothiazolinone and formaldehyde-releasing agents, nickel, lanolin, parabens, and certain surfactants used in soaps and cleansers. Hotel soaps, in particular, are notorious among allergists because their ingredient lists are frequently unknown or unavailable to guests, and formulations vary significantly from brand to brand.
Symptoms typically include redness, swelling, itching, bumps, or blisters at the site of contact. In Kai’s case, the neck reaction after using hand soap on her face is a textbook presentation.
Why You Cannot Identify the Culprit on Your Own
Here is the frustrating reality: most personal care products contain dozens of chemical ingredients, and sensitization can develop to any one of them, sometimes after years of using a product without any problem. The immune system can become sensitized gradually, which means a soap you used without issue for months can suddenly cause a reaction.
Self-diagnosis by process of elimination is slow, unreliable, and means continuing to expose yourself to potential triggers in the meantime. The only clinical way to identify the specific chemical responsible is through patch testing.
What Is Patch Testing and How Does It Work?
Patch testing is a straightforward, in-office procedure designed to systematically identify which substances your immune system is reacting to. At NY Allergy & Sinus Centers, the process works like this:
Small amounts of standardized allergens are applied to adhesive panels and placed on your upper back. These panels typically include 80 or more of the most common contact allergens, including the full North American Standard Series. The patches are left in place for 48 hours, during which you are asked to keep the area dry. They are then removed and your back is read at 48 hours, with a follow-up reading at 96 hours to capture the delayed responses that define ACD.
Each site is graded on a standardized scale ranging from no reaction to a strong positive with vesicles or spreading. A positive reaction at a specific site tells your allergist precisely which chemical triggered a response.
What Happens After You Get Your Results?
A positive patch test result is only the beginning. The critical next step is what allergists call relevance determination: figuring out whether the substances you reacted to actually explain your current skin symptoms and where those chemicals appear in your daily products.
Your NY Allergy & Sinus Centers provider will walk you through a detailed avoidance plan. This includes guidance on reading ingredient labels, which product categories most commonly contain your trigger chemicals, and how to identify safe alternatives. For patients who react to fragrances, for example, the avoidance strategy is more nuanced than simply buying products labeled “unscented,” since many of those products contain masking fragrances that still cause reactions.
For patients like Kai, who spend time in varying environments with access to unfamiliar products, knowing your specific triggers means you can ask the right questions, read labels with confidence, and avoid the kind of urgent medical situation that turned a week at the Masters into a medical emergency.
Who Should Consider Patch Testing?
Patch testing is appropriate for anyone who experiences recurrent or unexplained skin rashes, particularly if they occur on the face, neck, hands, or other areas regularly exposed to personal care products, jewelry, or occupational substances. It is also worth pursuing if you have a history of eczema that does not respond fully to standard treatment, since contact allergens frequently drive flares in eczema patients.
If your skin reacts to soaps, cleansers, lotions, cosmetics, sunscreens, hair dye, or even certain fabrics and metals, patch testing can give you the specific answers that guesswork never will.
Schedule a Patch Test at NY Allergy & Sinus Centers
Our allergists perform comprehensive patch testing across our New York locations. If you have experienced a reaction like Kai’s and want to know exactly what caused it, contact us today to schedule an evaluation. Identifying your contact allergens is the first step toward protecting your skin long term.