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DermNet NZ


Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Nickel allergy

What is nickel allergy?

Nickel allergy is one of the most common causes of contact allergic dermatitis. In affected individuals, dermatitis (also called eczema) develops in places where nickel-containing metal is touching the skin.

The most common sites for nickel dermatitis are the earlobes (from earrings), the wrists (from a watch strap) and the lower abdomen (from a jeans stud); the affected areas become intensely itchy and may become red and blistered (acute dermatitis) or dry, thickened and pigmented (chronic dermatitis).

Who is affected by nickel allergy?

Contact allergic dermatitis to nickel may develop at any age and in males and females. Once this nickel allergy has developed, it persists for many years, often life-long.

Nickel allergy is more common in women, probably because they are more likely to have piercings than men, although this is changing. The degree of allergy varies. Some people develop dermatitis from even brief contact with nickel-containing items, while others break out only after many years of skin contact with nickel.

Can nickel allergy affect areas that are not in contact with metal?

This has been debated by dermatologists.

Some people develop intermittent or persistent eczema on their hands and feet. It is usually a blistering type of eczema, known as pompholyx or dyshidrotic hand dermatitis. Sometimes it is due to contact with metal items containing nickel, but often there is no obvious reason for it.

It has been suggested that in nickel allergic people pompholyx may be due to nickel in the diet. Unfortunately it is not possible to avoid ingesting nickel as it is present in most foodstuffs. A low-nickel diet is only rarely helpful.

Nickel allergy
Due to jeans stud
nickel allergy
Due to rings
nickel allergy
Due to watch strap
nickel allergy
Spectacle frame
nickel allergy
Pompholyx in nickel allergic patient
nickel allergy
Strongly positive patch test to nickel sulphate
Nickel dermatitis

How is nickel allergy diagnosed?

Nickel allergy is diagnosed by the clinical history and by special allergy tests, patch tests.

Subjects undergoing baseline series patch tests are specifically tested to nickel sulphate-hexahydrate. The chemical formula for this is NiO4S.6H2O.

What is the treatment for nickel allergy?

Treatment is often necessary for nickel dermatitis.

Unfortunately, desensitization with injections or pills is not possible so the allergy tends to persist long-term.

Avoid skin contact with nickel

It is essential to avoid skin contact with nickel-containing metals.

Test your metal items

Test your metal items to see if they contain nickel. Obtain a nickel-testing kit from your dermatologist, pharmacist or online supplier. The kit consists of two small bottles of clear fluid; one contains dimethylglyoxime and the other ammonium hydroxide. When mixed together in the presence of nickel, a pink colour results.

Apply a drop from each bottle on to the metal item to be tested – first try it on a coin. Use a cotton bud to rub gently – observe the colour on the bud. If it remains clear, the item has no free nickel and will not cause dermatitis. If it is pink it contains nickel and may cause dermatitis if the metal touches your skin. The chemicals will not harm your jewellery.

Jewellery

Necklaces, necklace-clips, earrings, bracelets, watch-straps and rings may contain nickel. "Hypoallergenic" stainless steel, solid gold (12 carat or more) and silver jewellery should be safe. Nine-carat gold and white gold contain nickel. Plastic covers for earring studs can be obtained. Coating the stud with nail varnish is not recommended as the varnish soon chips off.

Nickel in clothing

Metal zips, bra hooks, suspender clips, hair-pins, buttons, studs, spectacle frames etc. are likely to contain nickel. Use substitutes made of plastic, coated or painted metal or some other material.

Nickel in personal articles

Personal items with nickel that may touch the skin causing dermatitis include mobile phones, lipstick holders, powder compacts, handbag catches, cigarette lighters, razors, keys, key rings, knives, and pens. These may sometimes cause dermatitis when they are within a pocket.

Metal items in the home

Cupboard handles, kitchen utensils, cutlery, toaster, metal teapots, scissors, needles, pins, thimble, vacuum cleaners, torches, bath plugs and many other items may contain nickel. Choose tools with plastic handles.

Stainless steel does not usually cause dermatitis unless it is nickel-plated.

Money

Silver-coloured coins are composed of cupro-nickel. Cashiers with nickel allergy may develop hand dermatitis from this source. Wear gloves to handle money or pay with a credit card or cheque.

Metal at work

Nickel dermatitis may be aggravated by contact with paper clips, typewriter keys, instruments, metal fragments from a lathe or chain saw.

Low nickel diet

This diet low in nickel-containing foods has been suggested to patients with severe contact allergy to nickel. Its efficacy is unknown.

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If you have any concerns with your skin or its treatment, see a dermatologist for advice.