What is jewelry allergy?
Jewelry (jewellery) allergy is a common cause of contact allergic dermatitis. Most jewelry allergy is caused by the metal nickel (see nickel allergy) which is used in the manufacture of precious metal alloys. In less expensive jewelry, nickel is often used in the base metal which is then plated with gold or silver. Many people who believe that they are allergic to gold or silver jewelry are actually allergic to nickel, which can occur as a trace element in gold or silver or has been used in the manufacture of gold jewelry to whiten and/or strengthen the piece.
In affected individuals, dermatitis (eczema) develops in places where nickel-containing metal is touching the skin. The most common sites of jewelry allergy are the earlobes (from earrings), the fingers (from rings), and around the neck (from necklaces); the affected areas become intensely itchy and may become red and blistered (acute dermatitis) or dry, thickened and pigmented (chronic dermatitis). Sometimes the dermatitis later affects areas that are not in contact with jewelry, particularly the hands. Pompholyx is a blistering type of hand dermatitis that is prevalent in people with a previous history of jewelry allergy, and may be due to contact with other sources of nickel such as coins and keys.
Other reasons to react to jewelry
Jewelry reactions are not always due to allergy to a specific metal. Consider other reasons for a rash in the site of a particular item of jewelry.
- Irritant contact dermatitis may be provoked by friction, surface particles and dirt on the metal, soap and/or water under the item or other non-metal components of the jewelry. Irritant reactions are more common in people that suffer from sensitive skin or atopic dermatitis.
- Psoriasis and vitiligo can koebnerise, i.e. arise at a site or injury; they could arise at the site of a tight watch strap, necklace or bangle for example.
- A piercing site may be infected with Staphylococcus aureus bacteria, resulting in oozing and crusting (impetigo or wound infection).
- Other causes for rashes should also be considered, particularly if patch tests prove negative.
How do I know if my jewelry contains nickel?
By looking at a piece of jewelry it is very difficult to determine whether or not it contains nickel. One should assume that all metal jewelry has some amount of nickel in it unless it made of stainless (surgical) steel, is either 18- or 24 carat gold, is sterling silver, or pure platinum.
Gold for jewelry is typically measured in karats (also spelled carats).
- 24 karat (pure gold) contains 99.9% gold (plus 0.1% other metal)
- 18 karat is 75% gold
- 12 karat is 50% gold
- 9 karat is 37.5% gold
To make up the rest of the metal, gold is alloyed with other metals. For people with metal allergy, particularly nickel allergy, the question is which metals is your gold jewelry alloyed with? Gold can be alloyed with many different types of metals which alter its hardness, colour and other properties. For example yellow gold may be alloyed with silver and copper, whilst white gold is usually alloyed with nickel. Rhodium, a silvery white metal related to platinum, is often used to plate yellow gold to make it into white gold. And even white gold with nickel is often rhodium-plated to make it appear whiter and shinier. Although the initial plating will protect you against any nickel in the gold, it eventually wears off over a period of months or years. This leaves the white gold (alloyed with nickel) in contact with your skin.
There are three grades of silver for jewelry – pure silver, sterling silver and silver-plated. Pure silver is 99.9% silver but can be too soft and malleable to handle when making into jewelry. Sterling silver is 92.5% pure silver alloyed with copper. In some cases of sterling silver, a small percentage of other metals may be in the mix so traces of nickel may be present. Silver-plated jewelry is a base metal (and may contain nickel) that has been plated with a fine layer of silver alloy.
Who is affected by jewelry allergy?
Allergic contact dermatitis to metal jewelry may develop at any age. In most cases this is due to nickel allergy and once it has occurred, it persists for many years, often life-long. Some people develop dermatitis (also called eczema) from even brief contact with nickel-containing items, while others after many years of wearing them without problems suddenly break out in a rash. This is usually confined to skin sites in contact with the metal, but can spread more widely in severe cases.
Nickel allergy is more common in women, probably because they are more likely to wear jewelry than men, although this is changing. Whilst nickel allergy is the most common jewelry allergy to occur, allergy to other metals used in jewelry is possible. However it appears to be rare.
Treatment of jewelry allergy
Treatment requires removing the responsible jewelry.
How to avoid jewelry allergy
If you have a jewelry allergy, a dermatologist can perform a simple skin patch test to determine if you have a nickel allergy. Once your nickel allergy is confirmed, it is essential to avoid contact with nickel-containing metals. The following tips may help when purchasing jewelry.
- Alternative white gold alloys are available based on palladium, silver and other white metals, but the palladium alloys are more expensive than those using nickel. High-karat white gold alloys are far more resistant to corrosion than are either pure silver or sterling silver.
- When having ears or other body parts pierced, have it done with a stainless steel needle and make sure your jewelry is made of stainless steel or either 18- or 24 karat gold.
- Look for jewelry that is hypoallergenic, i.e. made of stainless steel, at least 18-karat gold, sterling silver, or polycarbonate plastic.
- If you must wear earrings that contain nickel, add plastic covers made specifically for earring studs.
- If your wedding ring or other item of jewelry that you wear daily causes a reaction, you can ask a jeweler about having it plated in a non-allergic metal, such as rhodium or platinum. However, the coating will eventually wear off and need re-plating.
Test your metal items
Test your metal items to see if they contain nickel. Obtain a nickel-testing kit from your dermatologist or pharmacist. 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 10-cent 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 problems if the metal touches your skin. The chemicals will not harm your jewelry.
Your dermatologist may have further specific advice, particularly if you are highly sensitive to nickel or other metals.