Dermatitis from metals and metal salts is a kind of skin irritation. It happens when the skin comes in contact with certain metals or their salts. This can lead to redness, itching, swelling, and sometimes blistering.
Dermatitis from metals and metal salts, or ‘metal allergy,’ is a skin condition triggered by an allergic reaction to certain metals. Metals are common materials we encounter daily, from jewelry to coins to kitchen utensils. It’s easy to be in contact with them without giving it a second thought. But what happens when your body sees these ordinary substances as invaders? It responds with inflammation, leading to dermatitis.
Types of Metal-Induced Dermatitis
Nickel Dermatitis
Nickel is one of the most common culprits behind metal-induced dermatitis. It’s often used in everyday items like jewelry, zippers, eyeglass frames, mobile phones, and even some food and drink. Exposure to nickel can cause a reaction in those who are allergic. Symptoms typically include redness, itching, swelling, and sometimes blistering and weeping of the skin.
Chromium Dermatitis
Chromium is another metal known to cause dermatitis. It is found in items like leather goods, cement, and some paints. People working in industries that use these materials are particularly susceptible. Symptoms of chromium dermatitis resemble those of nickel dermatitis.
Cobalt Dermatitis
Cobalt, found in things like jewelry, certain paints, and metal alloys, can also provoke dermatitis in allergic individuals. Cobalt dermatitis symptoms mirror those of nickel and chromium dermatitis.
Other Metals
While nickel, chromium, and cobalt are the most common, other metals like gold, silver, copper, and zinc can also cause dermatitis in some individuals. The reactions and symptoms are usually similar.
Causes
Various everyday items, including jewelry, coins, cell phones, and even certain types of clothing, contain metals that could potentially trigger an allergic reaction. The following article lists and describes common causes of dermatitis from metals and metal salts.
- Nickel: This is the most common cause of metal allergy dermatitis. It’s found in jewelry, watches, eyeglass frames, and even some foods.
- Gold: Some people are allergic to gold, especially when it comes in direct contact with their skin, like in earrings or rings.
- Cobalt: This metal, often found in jewelry and some medical implants, can cause allergic reactions.
- Chromium: Used in the tanning of leather, some individuals may experience dermatitis from contact with leather products.
- Mercury: Though rare, some individuals may react to mercury found in dental fillings and some cosmetics.
- Copper: Copper bracelets and other jewelry can cause contact dermatitis in sensitive individuals.
- Zinc: Often found in cosmetics and lotions, zinc can cause skin irritation.
- Aluminum: Aluminum, which is commonly found in antiperspirants and cooking utensils, can cause allergic reactions.
- Silver: Silver, particularly in jewelry, can cause allergic contact dermatitis in some individuals.
- Iron: While rare, some people may experience reactions to iron, especially when it is used in certain medical treatments.
- Lead: Some traditional cosmetics and hair dyes contain lead, which can cause allergic reactions.
- Cadmium: Frequently used in inexpensive jewelry, cadmium can cause skin irritation.
- Tin: Some people may react to tin, which is commonly found in personal care products.
- Manganese: This is used in some batteries and ceramics, and can cause skin reactions.
- Beryllium: Beryllium is used in various industries and can cause allergic contact dermatitis.
- Platinum: Some people may react to platinum, often used in high-end jewelry and certain medical devices.
- Iridium: A component of some high-end jewelry and certain medical devices, iridium can cause allergic reactions.
- Palladium: Used in dental materials and electronics, palladium can lead to contact dermatitis.
- Lithium: Lithium, found in batteries and certain medications, can cause skin reactions.
- Vanadium: Vanadium, used in some alloys and ceramics, can cause allergic contact dermatitis.
- Titanium: Commonly used in medical implants and cosmetics, titanium can trigger skin reactions in some people.
- Ruthenium: Used in electronics and some jewelry, this can cause dermatitis.
- Thallium: Thallium, used in some electronics and glass manufacturing, can lead to contact dermatitis.
- Gallium: Gallium is used in semiconductors and can cause allergic reactions.
- Indium: Found in LCD screens, indium can lead to skin irritation.
- Arsenic: Exposure to arsenic in some pesticides and treated wood can cause dermatitis.
- Antimony: Found in some textiles and plastics, antimony can cause skin reactions.
- Chromium Salts: Used in leather tanning and some dyes, chromium salts can cause dermatitis.
- Copper Salts: Used in some fungicides and algicides, copper salts can cause skin reactions.
- Nickel Salts: Use
Symptoms
Symptoms of metal dermatitis.
- Itching: The most frequent symptom of metal dermatitis is itching, also known as pruritus. If you notice a persistent itch around areas in contact with metal objects, it could indicate metal dermatitis.
- Redness: Your skin may turn red, especially around the area that was in contact with the metal. This symptom, known as erythema, may sometimes be mistaken for a simple rash or irritation.
- Swelling: Another common symptom is swelling or edema. If your skin puffs up around an area where you wear metal, it could be a sign of metal dermatitis.
- Blisters: In severe cases, you might notice blisters forming. These small pockets of fluid can be itchy and painful.
- Dry, scaly skin: The affected area can become dry and show signs of scaling. This is due to the skin reacting to the irritation caused by the metal.
- Cracked skin: In some cases, the skin might become so dry that it starts to crack, creating small fissures. This can cause discomfort and even pain.
- Burning sensation: Some people may experience a burning sensation in the affected area. It’s similar to the sensation of a minor burn.
- Dark patches: Over time, chronic irritation can cause the skin to darken. This discoloration, known as hyperpigmentation, often persists even after the dermatitis has healed.
- Changes in skin texture: In some cases, the skin’s texture might change, becoming rougher or tougher in response to chronic irritation.
- Sensitivity to sunlight: The affected skin area may become more sensitive to sunlight, causing a stronger reaction to sun exposure than usual.
- Fluid discharge: When the condition is severe, fluid may start leaking from the affected skin area. This is often due to burst blisters.
- Rashes: Rashes often form on the affected area. These can range from small, pinpoint-sized bumps to larger, more widespread eruptions.
- Ulcers: In severe or untreated cases, ulcers or open sores may form. These require immediate medical attention.
- Pain: Not all cases of metal dermatitis involve pain, but it’s possible, especially in severe cases or when skin is cracked or has ulcers.
- Fever: In some cases, your body might react to the dermatitis by causing a fever. This is more common in severe cases where the body is fighting off an infection.
- Lymph node swelling: Swollen lymph nodes, particularly in the neck, armpit, or groin, can be a sign of a systemic reaction to the dermatitis.
- Change in skin color: Besides dark patches, some people may notice a general change in skin color. The affected area might appear lighter or redder than the surrounding skin.
- Nail changes: If the skin around your nails is affected, you may see changes in your nails as well. This could include discoloration, ridges, or nail loss.
- Hair loss: If metal dermatitis affects your scalp, it might lead to hair loss in the affected area.
- Fatigue: Though not a direct symptom of the skin condition, dealing with persistent discomfort and itchiness can lead to feelings of fatigue or tiredness.
Diagnosis
Diagnosis and Tests for Dermatitis from Metals and Metal Salts
The diagnosis of metal-induced dermatitis often begins with a detailed patient history and physical examination. However, for a definitive diagnosis, other specific tests are typically required. Below are 30 commonly utilized diagnostic methods and tests:
- Patch Testing: The gold standard in diagnosing contact dermatitis. Small patches impregnated with potential allergens, including metal salts, are applied to the skin. If the skin reacts with inflammation, a diagnosis can be confirmed.
- Skin Examination: A thorough skin examination helps identify signs of dermatitis, such as rash, redness, blisters, or swelling.
- Medical History: The patient’s personal or family history of allergies can offer valuable insights into potential triggers of dermatitis.
- Allergy Blood Tests: Although less accurate than skin tests, these help measure the number of certain antibodies produced by your immune system in response to an allergen.
- Prick Test: Tiny amounts of allergens are pricked into the skin surface to check for reactions. This isn’t typically used for metal allergies but may help identify additional allergens contributing to the dermatitis.
- Nickel Spot Test: Specifically for identifying nickel, one of the most common metals causing dermatitis.
- Photopatch Testing: This is similar to patch testing but involves two rounds of patches to evaluate if sunlight exposure worsens the skin’s reaction.
- Intradermal Test: Involves injecting a small amount of allergen under the skin to look for a reaction.
- Use Testing (Open Application Test): Regular application of a product suspected to cause a reaction, under medical supervision, to see if it triggers dermatitis.
- Repeated Open Application Test (ROAT): A form of use test where a product is repeatedly applied to look for delayed reactions.
- Elimination Diet: If oral exposure to metals is suspected, avoiding foods with high metal content can help confirm the diagnosis.
- Oral Challenge Test: Under strict medical supervision, the patient consumes a small amount of a suspected allergen to check for reactions.
- Atopy Patch Test: Useful in diagnosing allergic contact dermatitis in patients with atopic dermatitis.
- Lymphocyte Transformation Test (LTT): A blood test designed to identify allergen-specific T cells.
- X-ray: To rule out other skin diseases.
- Biopsy: Removal of a small skin sample to check for signs of inflammation under a microscope.
- Epicutaneous Test: Another type of skin test, where an allergen is applied onto a punctured skin area.
- Provocative Use Test (PUT): Application of suspected allergenic substances under real-life conditions for a certain period.
- Measurement of Metal Levels in Blood: High levels can indicate exposure, although this doesn’t prove an allergy.
- Measurement of Metal Levels in Urine: Like blood tests, useful in determining exposure levels.
- Laboratory Skin Tests: Involves applying potential allergens to a small piece of your skin in a lab.
- Skin Challenging Test: Similar to a patch test, but for immediate allergic reactions.
- Basophil Activation Test (BAT): A blood test that measures basophil (white blood cells) activation when exposed to an allergen.
- Component Resolved Diagnosis (CRD): Identifies the specific molecular components causing an allergic reaction.
- Comet Assay: Measures the amount of DNA damage in individual cells after exposure to a suspected allergen.
- Lymphocyte Proliferation Test: Measures the response of lymphocytes (type of white blood cells) to allergens.
- Skin Prick-to-Prick Test: Freshly prepared allergen extracts are used in skin prick testing.
- Controlled Usage Test: Patients use suspected products under normal conditions to see if they cause reactions.
- Cross Reactivity Tests: If a patient is allergic to one metal, they may be allergic to others. This test determines potential cross-reactivity.
- Provocation Tests: Involves deliberate exposure to a suspected allergen under controlled conditions.
Treatment
Different treatment options, are designed to manage symptoms and prevent outbreaks.
- Avoidance:
The primary and most effective way to treat metal dermatitis is by avoiding contact with the metal causing the allergy. This may involve changing your jewelry, clothing, or other personal items that might contain the offending metal.
- Topical Steroids:
These creams or ointments can reduce inflammation and itchiness. Hydrocortisone, a mild topical steroid, can be bought over the counter. Stronger versions, like betamethasone, require a prescription.
- Antihistamines:
Oral antihistamines such as cetirizine, loratadine, or fexofenadine can help control itching. They work by blocking the body’s histamine receptors, reducing the allergic response.
- Topical Calcineurin Inhibitors:
Tacrolimus and pimecrolimus are medications that reduce skin inflammation without the side effects of steroids. They are often used if steroid creams aren’t effective.
- Moisturizers:
Dryness can worsen dermatitis. Regularly applying a hypoallergenic moisturizer can help keep the skin hydrated and enhance its barrier function.
- Cold Compresses:
Applying a cold, wet cloth to affected skin can soothe itching and reduce inflammation.
- Over-the-counter Hydrocortisone:
A mild corticosteroid cream that can help with minor inflammation and itching. Always follow the product instructions.
- Barrier Creams:
Creams like petrolatum can provide a protective layer on the skin, preventing allergens from coming into direct contact.
- Emollients:
These products, which include bath oils and creams, can help repair skin and reduce dryness, keeping your skin moist and supple.
- Phototherapy:
This involves exposure to certain types of light to reduce inflammation. It’s often used for severe cases that don’t respond to other treatments.
- Patch Testing:
Identifying the specific metal causing the reaction can help you avoid it. Dermatologists do this by applying small amounts of various substances to your skin and checking for a reaction.
- Oral Steroids:
Prescribed for severe cases, these drugs, such as prednisone, can quickly reduce inflammation.
- Systemic Immunosuppressants:
Medications such as methotrexate, cyclosporine, or azathioprine may be used in severe, resistant cases, although they come with potential side effects and require careful monitoring.
- Antibiotics:
If the skin becomes infected, topical or oral antibiotics may be necessary.
- Allergen Immunotherapy:
A treatment where the body is gradually exposed to small amounts of the allergen, aiming to desensitize the immune system over time.
- Non-sedating Antihistamines:
Such as fexofenadine, these do not cause drowsiness and can be beneficial in controlling itching.
- Wet Wrap Therapy:
A treatment often used for severe dermatitis, where topical medications are applied and then covered with wet bandages to enhance their effects.
- Bleach Baths:
A mild bleach bath can help reduce bacteria on the skin and decrease inflammation.
- Dietary Changes:
For some people, certain foods may exacerbate skin inflammation. Identifying and avoiding these foods can help manage symptoms.
- Probiotics:
There’s some evidence that these beneficial bacteria can boost the immune system and might help control dermatitis.
- Zinc Supplements:
Zinc is essential for skin health and healing. Supplements may be beneficial in some cases.
- Witch Hazel:
A natural anti-inflammatory that can be applied topically to soothe irritated skin.
- Oatmeal Baths:
These can soothe and moisturize skin, reducing itching and irritation.
- Aloe Vera:
A natural remedy with anti-inflammatory properties, aloe can be applied topically to soothe the skin.
- Chamomile:
Chamomile cream or a cool chamomile tea compress can provide soothing relief to irritated skin.
- Hypoallergenic Jewelry:
Switching to jewelry made from hypoallergenic materials, like stainless steel or titanium, can help avoid flare-ups.
- Salicylic Acid:
A component in some creams and ointments, salicylic acid can help remove dead skin cells and reduce inflammation.
- Evening Primrose Oil:
A natural remedy that contains an anti-inflammatory substance known as gamma-linolenic acid.
- Omega-3 Fatty Acids:
Found in fish oil and flaxseeds, these fats have anti-inflammatory properties that can be beneficial for skin health.
- Epsom Salt Baths:
A warm bath with Epsom salts can soothe the skin, reduce inflammation, and promote relaxation.
Conclusion:
While there’s no cure for dermatitis from metals and metal salts, the condition can be managed with careful avoidance strategies and a range of medical and natural treatments. It’s essential to consult with a dermatologist or healthcare provider to find the most effective treatment plan for your specific condition. Remember, each person’s reaction to treatment can vary, and what works for one may not work for all.