Nickel Allergy: What To Look For (And Avoid)

Is Your Jewelry Causing Your Skin Harm?

This is a scenario we encounter far too often. You find a beautiful necklace. It looks amazing on you. Then a few days later, a red, unsightly rash shows up on your skin. Upon a closer look, it looks like the same shape as that latest purchase. Chances are, what you’re experiencing is a nickel allergy, and it’s is an excellent time to see a dermatologist ASAP. These types of allergies are typical and must be addressed to avoid future discomfort and flare-ups.

What is nickel?

When you bought your necklace, you weren’t specifically buying nickel. Nickel is a silvery-white metal that’s been around for thousands of years. Its strength and versatility make it perfect for mixing with other metals to create stronger alloys. And since it’s more resistant to corrosion, it’s an excellent replacement for decorative silver. You’d often find nickel in stainless steel, specifically watches, bracelets, necklaces, belt buckles, hairclips, clasps, zippers, and more. Nickel is also present in everyday items like stationery, keys, pots and pans, and household tools. 

Understanding Contact Dermatitis

So what’s happening with your skin? Do you suspect that this sudden rash has something to do with your jewelry? Your nickel allergy is actually a condition called Contact Dermatitis. As the name suggests, contact dermatitis is a skin reaction upon contact with an object. Contact dermatitis could be broken down into three types:

1. Irritant Contact Dermatitis

Irritant Contact Dermatitis or ICD happens when a substance causes an allergic reaction to the outer skin. The skin comes into immediate contact with the allergen – often due to friction – and a rash, irritation, and redness happens. Irritant contact dermatitis can happen from everyday items like:

• Soaps
• Perfumes, certain 
• Household cleaners
• Pesticides and fertilizers
• Bleach, chlorine, and other harsh solvents

You can also develop ICD from: 

• Dust and other airborne particles
• Acids, alkalis, and adhesives 
• Saliva from lip-licking (especially in children), dry air, and contact with insects.

The condition is dose-dependent. You can get in contact with a large amount of a harmful substance like a pesticide, or you can have repeated exposure to a supposedly harmless substance like a body wash. Most contact dermatitis cases are irritant-related and can happen to anyone. However, people with eczema are more likely to develop ICD. 

2. Allergic Contact Dermatitis

Allergic Contact Dermatitis or ACD brings a more delayed response that can be more distressing compared to ICD. About 20% of patients with contact dermatitis have ACD. With ACD, skin contact with a particular substance causes a delayed immune response. People with ACD are often exposed to the allergen without a reaction at first. Then another interaction weeks, months, or even years later can cause an allergic reaction. 

Nickel is one such allergen. So if you have an adverse reaction, it’s ACD. Other allergens include: 

• Cobalt, copper, and other metals
• Plasters
• Reactions to certain sunscreens that can contain trace metals
• Poison ivy and herbal products
• Certain antihistamines and antibiotics
• Inks and dyes
• Perfumes and fragrances in everyday items
• Acrylics and cosmetics
• And hundreds of other substances

Because your immune system is at play, the slightest exposure to the allergen can cause a flare-up. Your nickel allergy can even spread to other parts of your body since your immune system reacts negatively to the allergen. You can also pass the rash to other parts of your body, like your face or genitals, if the inflammation is on your hands. 

3. Systemic Contact Dermatitis

Systemic Contact Dermatitis or SCD is similar to allergic dermatitis. Instead of the reaction happening from skin contact, the allergic response happens from inhaling, ingesting, or injecting the allergen. The same allergens that cause ACD can cause SCD. Systemic dermatitis often happens due to:

• Trace allergens in foods and drinks
• Medication
• Trace allergens in spices, balsam of Peru, and garlic
• Pesticides sprayed on fruits and vegetables

SCD presents in different ways. Once you ingest the allergen, you can see a flare-up at the same site you had a past reaction. However, there are cases where the entire back, legs, or buttocks can develop a red, blotchy rash.

What’s behind the naughty nickel allergy?

Researchers, dermatologists, and scientists are unable to find the real cause of nickel allergies. No evidence points to sex or race. However, many believe that you could inherit the allergy. For some people, the immune system sees nickel as a harmful substance. When traces of nickel go through the skin’s outer layer, it’s picked up by proteins that get attacked by the immune system. The reaction happens 24 to 72 hours later (Allergic Contact Dermatitis is sometimes called a delayed hypersensitivity). 

What does a nickel allergy look like?

The nickel allergy shows up on the part of the skin where the contact occurred. It often takes the shape of the item like a watchband, bracelet band, or belt buckle. In some cases, like with systemic contact dermatitis, the allergy can show up on other parts of the body. Look for the following symptoms:

• The nickel allergy looks like a red patch and bumps on the skin.
• For darker skin, the rash can cause the skin to look darker.
• Dry patches that look like burn marks.
• The rash feels tender to the touch or leaks fluid.
• In the case of sunscreen, harsh rashes appear on the arms and legs where you applied the cream.
• Rashes that come and go at the same spot on your skin.

If these symptoms show up on your arms, face, and you’re not sure where the rash came from, make sure to see your dermatologist immediately. 

Consider these risk factors.

There are some cases where you are more likely to develop a nickel allergy. Metalworkers, jewelers, and those in contact with nickel and other metals can develop contact dermatitis. We also see nickel allergies in patients with several piercings or those who tend to wear lots of jewelry. If someone in your family has a nickel allergy or is allergic to other metals, you’re more likely to develop the condition. If you see a sudden rash, try to retrace your steps to an occasion where you touched or interacted with stainless steel, jewelry, or other metals. 

Can a nickel allergy be cured?

Once the immune system decides that nickel is harmful, you will always have a nickel allergy. That means anytime you come into contact with nickel, either through friction on your skin or ingested, you’ll have a flare-up. Unfortunately, there is no cure. What you can do is take some precautions and treatment to reduce the symptoms of ACD. 

Your first step is to see a dermatologist immediately. At Eternal Dermatology, we are the premier facility for treating a nickel allergy in Columbia, MD, Howard County, and the DC – Baltimore area. If you aren’t in the area, search “nickel allergy near me” or “contact dermatitis near me” for a list of dermatologists in your area who can help.

Initial consultation and the “open application test.”

Before starting treatment, we will ask a series of questions that can pinpoint if there is indeed a nickel allergy. We need to know about your family history, previous rashes, your work environment, or any recent changes in your routine. We’ll also perform a physical exam to pinpoint the symptoms of a nickel allergy. Sometimes, the info is enough for us to confirm ACD. 

If we believe that the nickel is in a product like a lotion or a sunscreen, we’ll try an open application test. With this test, we will have the patient apply the product on a patch of skin to see if there is an adverse reaction. If the skin develops a rash, we can confirm the nickel allergy and start with treatment.

Moving to an allergy patch test

An open application test may not be enough to confirm the nickel allergy. So we can perform an allergy patch test. Patch testing is a simple procedure where we apply several potential allergens (up to 80+) to your skin for a short period. If your skin reacts to nickel or other allergies, we can confirm that you have a nickel allergy.

Finding an allergy patch test near me!

To get a patch test, contact your local dermatologist to confirm that they provide allergy testing. Your doctor will ask you to bring any household products, skincare products, or perfumes that you may suspect are behind the reaction. The doctor will place small samples of the products and over 30 other potential allergens, on small patches. These patches are then applied on several strips onto your back. 

You will have to keep the patches applied for a few days, making sure to not get them wet. At the 48 hour mark, you’ll come back to your dermatologist to remove the patches. From there, the doctor will take note of any allergens (which would have been labeled prior) that created an adverse reaction. You may have a follow-up appointment to confirm any allergies and to undergo treatment if necessary. 

Use these dermatologist-recommended treatments.

If your nickel allergy or rash is still present at this point, we can prescribe medication to help treat the inflammation and symptoms. If the nickel allergy affects a large part of your body, for example, in cases where it’s ingested, you may need oral steroids. Make sure to take the medication as directed to avoid any unwanted side effects. Your dermatologist may request a follow-up visit to check on your progress or prescribe more medication. While medical treatment helps, there are some steps you should take to avoid or prevent the allergy. 

Avoid these things that may contain nickel.

One of the best ways to fight your nickel allergy is to avoid the things that contain nickel. In some cases, this may be easier said than done. However, you’ll run the risk of having more severe reactions with prolonged exposure. The allergy can bring discomfort, impact your social life, and can rack up your medical expenses in the long-run. 

• Avoid stainless steel jewelry, piercings, and other items that contain nickel. 
• Use cloth covers on zippers, clasps, and buttons that can cause unwanted reactions. 
• Remove products in your home that are known to have nickel, including high-nickel foods.
• If you work with or around nickel, wear the appropriate protective gloves and clothing to reduce the risk of exposure. 
• If you need advice, speak with your dermatologist. 

Take care of your skin at home.

With or without the skin reaction, taking care of your skin is one of the most effective ways to treat your flare-up. For starters, make sure use a moisturizer that’s fragrance-free, paraben-free, and contains ceramides and hyaluronic acid. These creams can help restore the epidermal barrier damaged by the rash. If the itching continues, use a wet compress.

Get your nickel allergy under control with Eternal Dermatology.

Most metal allergies aren’t life-threatening. However, they can cause severe discomfort and irritation if left untreated. Some people may feel self-conscious, especially if the allergy happens on their face and arms. Luckily, you can identify nickel allergies through the large, tender rashes that occur at the contact site. Think back to occasions where you have come into contact with nickel, then see your dermatologist immediately. 

At Eternal Dermatology, we’ve helped countless patients with contact dermatitis and metal allergies using allergy patch testing and effective medication. Together with consistent skincare and a few precautions, you can keep your nickel allergy under control. Contact Eternal Dermatology and our nickel allergy specialist, Dr. Ife Rodney, MD, FAAD, via our website or schedule an appointment today. 

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