Contact Dermatitis

Contact Nickel Allergy: Allergic Contact Dermatitis

Nickel is the most common cause of skin allergies. Nickel isn’t just a metal in coins. It is an inexpensive, durable metal that is mixed into many metal alloys. It is also one of the most common causes of allergic contact dermatitis even when mixed with other metals. Allergic contact dermatitis is an allergic reaction where you can get a rash days after coming into contact with an allergen. Studies estimate that about 9% of the population has a nickel allergy.  Because nickel is such a commonly used metal, nickel allergies can be difficult to manage.  We have compiled the latest information to help you control your allergy.

Here are some classic stories of someone who might have an allergic contact dermatitis to nickel:

Alex is constantly itching. She has noticed that her face is very red, itchy, and scaly, especially on her eyelids. She has tried things like moisturizing more but it has never completely solved her problems. Alex also loves jewelry. She has a large necklace collection at home and loves wearing them everyday. However, she noticed that her chest is often itchy and redder than the rest of her body

Sam can’t stop itching around his waist. He has a very bad rash near her belly button, almost like he was touched by poison ivy. His rash gets a little better when he has lazy weekends and wears sweatpants, but always gets worse over the course of the week when he has more formal attires.

In these cases, we would be suspicious of Alex’s necklaces (and her environment) and Sam’s belt and pant buttons as potential causes for their rashes. Real cases are usually much more complicated than these simplified stories, but they don’t have to be. If these stories sound similar to yours, it might be worth investigating if you have allergic contact dermatitis to nickel.

What is it found in?

Chances are that if the item has metal in it, then it likely has some nickel. This includes items like glasses and jewelry (e.g. metal earrings, necklaces, and bracelets). A common offender that people don’t usually think about is clothing. Belt buckles, metal zippers, and buttons are all sources of metal that can be a continuous source of nickel. Other household items that we use everyday are things like door knobs, keys, and cell phones. If it looks metallic, beware of nickel.

Nickel is also found in small amounts in the foods that we eat. In fact, in a normal diet, a person consumes between 0.22 mg and 0.35 mg of nickel everyday.  Some foods, like grains, beans, and chocolate, have higher levels of nickel. 

Where will you be itching?

As with any contact allergen, itching and rashes occur at the site of contact. As we’ve mentioned above, jewelry is a common offender. As a result, people will get itching, redness, and scaling on wrists (bracelet), neckline (necklace), and ears (earrings). Pant buttons and belts are another common source of nickel and will cause people to be itchy and have redness around their belly button. Nickel is also on common handheld items, like doorknobs and keys. Since people touch their faces, it is common to develop rashes over the entire face, especially over the more sensitive eyelids. In more severe cases, these lesions can even progress to blistering. In rare cases the rash can occur systemically through the nickel we ingest in our diet.

What is the treatment?

Avoidance is the best policy. Here are some strategies you can use to avoid nickel:

  • Avoid wearing jewelry that is not 18k gold, sterling silver, platinum, or titanium. As mentioned above, many metals contain at least some nickel which can spark a reaction. Choose only pure metal jewelry to avoid those mixed with nickel.
  • Cover metal handles and keys. Door handles and keys are two sources of metal that people don’t often think about. Covering your handle with duct tape and using plastic or rubber key guards can help you avoid coming in contact with nickel. Alternatively, you can paint your door handles with clear nail polish to create a protective layer between you and metal.  Beware though! Nail polish will come off over time, so it may require occasional reapplication.
  • Use plastic zippers or fasteners. Buttons and zippers are other sources of metal which you want to avoid.
  • Use wooden, rubber, or plastic utensils/ tools. Silverware for cooking is another source of nickel. Try using utensils made of other materials. If you can’t avoid touching metal, then use vinyl gloves to prevent direct skin-to-allergen contact.

As always, reading labels is a good way to make sure the product you are using does not contain nickel. We know that checking the label on everything can be tough.

Some studies have also shown that low nickel diets can also help relieve symptoms. Let’s say you’ve been patch tested and you’re allergic to nickel. This is the time when trying a low nickel diet might be worth a shot.

Not sure if an item has nickel? Try a nickel test kit. Just put a couple drops of solution on some cotton, rub the item, and see if it changes color.

Do you have a severe rash now? There are some things you can do in the meantime until you figure out the cause. Barrier creams are thick oily greasy moisturizers. Applying barrier creams, like Vaseline, can help prevent the allergen from reaching your skin. Meanwhile, topical steroids can be used to reduce the severity of your rashes.

How is it diagnosed?

If you think nickel is causing your rash, you can try avoiding the products we have listed above and see if the rash goes away. For example, in our cases above Alex could avoid wearing jewelry that isn’t made of pure metal and put a clear coat of nail polish on her doorknobs and metal handles within her house. If the rash comes back when you reuse the substance, then you may have found your culprit.

Contact allergens can be tricky! See our main page for the many other contact allergens. If you are unsure whether or not you have a nickel allergy, talk to your dermatologist about patch testing. Patch testing is used to help doctors determine whether you have a true skin allergy (allergic contact dermatitis) or an irritant contact dermatitis (click here for the difference). This is determined by putting together your history, your job, your exposure, the environment, and your patch testing results.

References

Brod, BA. Management of allergic contact dermatitis. In: UpToDate, Post TW(Ed), UpToDate, Waltham, MA. (Accessed on March 3, 2016.)

Lu, L. K., Warshaw, E. M., & Dunnick, C. A. (2009). Prevention of Nickel allergy: the case for regulation?. Dermatologic clinics, 27(2), 155-161.

Rietschel, R. L., Warshaw, E. M., Sasseville, D., Fowler Jr, J. F., DeLeo, V. A., Belsito, D. V., … & Marks Jr, J. G. (2007). Common Contact Allergens Associated with Eyelid Dermatitis: Data from the North American Contact Dermatitis Group 2003‐2004 Study Period. Dermatitis, 18(2), 78-81.

Thyssen, J. P., Linneberg, A., Menné, T., & Johansen, J. D. (2007). The epidemiology of contact allergy in the general population–prevalence and main findings. Contact dermatitis, 57(5), 287-299.