Nickel Dermatitis

Nickel dermatitis, also known as nickel allergy or allergic contact dermatitis, is a common skin condition that arises from an allergic reaction to nickel. This widely-used metal is present in many everyday items including jewelry, coins, eyeglasses, and even cellphones. Understanding this condition is crucial for managing symptoms and reducing discomfort.

Types

1. Acute Nickel Dermatitis:

Acute nickel dermatitis is the first type of nickel allergy you may encounter. It’s characterized by an immediate, intense reaction that typically occurs within 48 hours after exposure to nickel. Symptoms may include redness, itching, and swelling. In severe cases, blisters may also form.

2. Chronic Nickel Dermatitis:

A chronic nickel dermatitis is a long-term form of the condition that results from prolonged exposure to nickel. The skin may become thick, discolored, and leathery due to constant itching and scratching. This type of dermatitis may be persistent and could take longer to treat due to continuous exposure.

3. Systemic Nickel Dermatitis:

Systemic nickel dermatitis, also known as systemic nickel allergy syndrome (SNAS), is a systemic immune reaction to nickel. This means that nickel ingested or inhaled, not just contacted, can trigger an immune response. Symptoms can include not just skin reactions, but also gastrointestinal issues like nausea, vomiting, and diarrhea.

4. Allergic Contact Cheilitis:

While not a separate type, allergic contact cheilitis deserves mention. It’s a form of dermatitis that specifically affects the lips due to contact with nickel, often found in certain cosmetics or dental materials. Symptoms can include dryness, redness, swelling, and even ulcers.

Causes

1. Jewelry Contact: Many pieces of jewelry contain nickel, which can trigger an allergic reaction, resulting in dermatitis. The repeated, prolonged exposure often worsens the reaction over time.
2. Clothing Fasteners: Buttons, zippers, and other metallic fasteners on clothing often contain nickel, which can lead to skin irritation and, subsequently, dermatitis.
3. Eyeglass Frames: Nickel-containing eyeglass frames can cause dermatitis around the ears, nose, and on the cheeks.
4. Watches and Bands: Wristwatches and fitness bands often have nickel parts, which, when in prolonged contact with the skin, can lead to dermatitis.
5. Cosmetics: Certain cosmetics may contain nickel and cause an allergic reaction.
6. Tattoo Ink: Nickel may be present in black tattoo ink, leading to dermatitis in people who are sensitive.
7. Orthodontic Appliances: Braces, retainers, and other orthodontic appliances can contain nickel, potentially causing oral or perioral dermatitis.
8. Coins: Handheld metallic objects, like coins, often contain nickel, which can cause a reaction.
9. Keys: Nickel-containing keys can trigger a reaction in individuals who are sensitive.
10. Mobile Devices: Some cell phones, laptops, and tablets contain nickel and may cause dermatitis with prolonged skin contact.
11. Belt Buckles: Nickel belt buckles can trigger contact dermatitis in the waist area.
12. Kitchen Utensils: Nickel-plated utensils and cookware can lead to hand dermatitis.
13. Body Piercing: The use of nickel-containing posts or hoops in body piercing can cause localized dermatitis.
14. Work Tools: Tools with nickel-containing parts can cause hand dermatitis.
15. Hair Pins and Clips: Hair accessories with nickel may lead to scalp or neck dermatitis.
16. Musical Instruments: Instruments with nickel parts, like guitar strings, can lead to dermatitis on the fingers and hands.
17. Prosthetic Joints: Some prosthetic joints have nickel components, potentially causing systemic dermatitis.
18. Dental Prostheses: Nickel in crowns or bridges can cause oral dermatitis.
19. Medical Devices: Nickel is used in some medical devices and implants, potentially causing an allergic reaction.
20. Door Handles: Frequent contact with nickel-plated door handles can trigger hand dermatitis.
21. Pens and Pencils: Writing instruments with nickel parts can cause a reaction.
22. Cigarette Smoke: Cigarette smoke contains traces of nickel, which can potentially lead to dermatitis in some individuals.
23. Food: Certain foods like chocolate and nuts have high nickel content, which may cause systemic dermatitis when ingested.
24. Laundry Detergents: Some detergents contain nickel, potentially causing dermatitis with clothing contact.
25. Nail Polish: Some nail polishes contain nickel, causing dermatitis around the nails.
26. Hair Dyes: Nickel in hair dyes can trigger scalp dermatitis.
27. Sweat: Sweat can release nickel ions from objects, increasing skin exposure and triggering a reaction.
28. Shaving Blades: Nickel-plated razors can lead to dermatitis on the face, legs, or underarms.
29. Artificial Jewelry: Costume jewelry often contains nickel, causing reactions.
30. Nickel-Plated Home Items: Household items like faucets, scissors, and light fixtures often contain nickel, leading to potential exposure and dermatitis.

Symptoms

We’ve compiled a list of 20 symptoms that may point to this condition. If you’re experiencing these symptoms, it’s important to seek medical advice. Let’s explore these symptoms and deepen our understanding of nickel dermatitis:

1. Skin Redness: One of the first symptoms you might notice is redness of the skin where the nickel-containing item touched your body. This can happen immediately or may develop over several hours.
2. Rash: A rash is a common sign of nickel dermatitis. The rash often appears as a dry, scaly, or rough patch on the skin.
3. Itchiness: Nickel dermatitis can cause persistent and intense itching. This is due to the immune system’s reaction to the nickel allergen.
4. Bumps or Blisters: Small bumps or blisters may appear, especially in severe cases. These can be filled with fluid and may burst if scratched.
5. Swelling: The area where the nickel touched the skin can become swollen and inflamed, adding to discomfort.
6. Skin Lesions: Over time, repeated exposure to nickel can cause skin lesions. These are abnormal growths or patches on the skin that can be a sign of long-term damage.
7. Dry Patches: Dry, flaky patches on the skin may be a sign of nickel dermatitis. The skin loses its ability to retain moisture due to the allergic reaction.
8. Skin Discoloration: In some cases, nickel dermatitis can lead to changes in skin color, usually in the form of darkening.
9. Warmth: The affected area may feel warm to the touch, a direct result of inflammation caused by the allergic reaction.
10. Pain: Though less common, nickel dermatitis can cause pain, especially if the skin is severely inflamed or if blisters are present.
11. Cracking Skin: Over time, the skin affected by nickel dermatitis may become rough and start cracking. This can be quite painful and increase the risk of infection.
12. Peeling Skin: In the healing phase, your skin may start peeling off. This is a natural part of the skin’s recovery process.
13. Hives: In severe cases, you may develop hives – red, raised, itchy welts on the skin.
14. Weeping Wounds: Some blisters may burst and seep fluid, leading to weeping wounds.
15. Bleeding: Excessive scratching due to the itching can lead to broken skin and bleeding.
16. Ulceration: Long-term exposure and constant scratching can result in ulcers on the skin.
17. Scarring: If the skin is repeatedly damaged and healed, it can eventually lead to scarring.
18. Sensitivity to Sun: Areas affected by nickel dermatitis can become more sensitive to the sun, leading to sunburns more easily.
19. Infection: If the skin becomes broken or raw, it becomes vulnerable to bacterial infections.
20. Hyperpigmentation: After the rash has healed, the skin may darken in the area, a condition called hyperpigmentation.

Each of these symptoms can vary in severity and duration. Some people may only experience mild itching and redness, while others could suffer from blisters and severe skin damage. If you’re experiencing any of these symptoms, consider getting tested for a nickel allergy.

Diagnosis

A Comprehensive Guide to Diagnosing and Testing Nickel Dermatitis

1. Clinical History: Dermatologists first evaluate the patient’s clinical history, assessing their exposure to common sources of nickel like jewelry, keys, coins, and certain electronic devices. Regular interaction with these items can cause nickel dermatitis.
2. Physical Examination: A visual examination of the skin helps doctors identify the signs of nickel dermatitis, such as redness, bumps, blisters, and dry or cracked skin. This assessment forms a critical part of the diagnostic process.
3. Patch Testing: The gold-standard for diagnosing nickel dermatitis is a patch test. Small quantities of potential allergens, including nickel, are applied to the skin using patches. If the skin shows a reaction, a nickel allergy is confirmed.
4. Prick Testing: Another method of diagnosing allergies, prick testing involves applying potential allergens to the skin using a small needle prick. If the skin develops a raised bump, an allergy is likely.
5. Intradermal Testing: Intradermal testing involves injecting a small amount of allergen under the skin. It’s used when patch or prick tests are inconclusive. If the skin reacts, an allergy is confirmed.
6. RAST Test: The Radioallergosorbent (RAST) test is a blood test that detects specific antibodies to allergens. It helps determine if a person is allergic to nickel.
7. ELISA Test: An Enzyme-Linked Immunosorbent Assay (ELISA) test is another blood test that identifies antibodies produced in response to a nickel allergy.
8. Challenge Test: A challenge test involves exposing the patient to nickel under a controlled setting to monitor any reactions.
9. Biopsy: In some cases, a biopsy may be performed to rule out other conditions. A small piece of skin is taken for examination under a microscope.
10. Histological Examination: A histological examination, or skin biopsy, can confirm the presence of allergic contact dermatitis caused by nickel.
11. Lymphocyte Transformation Test (LTT): An LTT checks the response of lymphocytes to nickel in vitro, aiding in the diagnosis of nickel allergy.
12. Dimethylglyoxime (DMG) Test: DMG test is a quick, in-home test that detects nickel presence in objects. It doesn’t diagnose nickel dermatitis but helps patients avoid nickel exposure.
13. Metalloproteins Measurement: The body sometimes produces proteins called metalloproteins in response to nickel exposure. Measuring these can help diagnose nickel dermatitis.
14. Atopy Patch Test: Atopy patch tests can help diagnose nickel dermatitis in people with atopic dermatitis, a condition that often co-exists with nickel allergies.
15. Interferon-gamma Release Assay: This test measures the immune system’s response to allergens, helping diagnose nickel allergy.
16. Patch Test Reading: Doctors evaluate the skin’s response to the patch test after 48 hours, 72 hours, and in some cases, even after one week.
17. Repeat Open Application Test (ROAT): This involves applying a potential allergen, like nickel, to a specific area of skin over several days to observe any reactions.
18. Use Test: A use test involves the person using suspected items (like jewelry) normally and watching for a skin reaction.
19. Scratch Test: A scratch test is another skin test where an allergen is applied to a small scratch or prick on the skin.
20. Provocative Use Test (PUT): In a PUT, suspected items are deliberately rubbed onto the skin to check for an allergic reaction.
21. Comet Assay: Comet assay is a cellular test used to detect DNA damage, which could occur in some cases of nickel dermatitis.
22. Enzyme Assays: Enzyme assays measure the activity of specific enzymes that may be involved in an allergic reaction to nickel.
23. Leukocyte Migration Test: This test studies the migration of leukocytes in the presence of nickel, assisting in diagnosing nickel allergy.
24. Serum IgE Measurement: This test measures the level of IgE, an antibody that the body might produce in response to a nickel allergy.
25. Basophil Activation Test (BAT): The BAT measures the activation of basophils (a type of white blood cell) in the presence of nickel, aiding in diagnosis.
26. Cytokine Profile: This test determines the levels of cytokines, substances that are released during an allergic reaction to nickel.
27. Epicutaneous Test: This involves applying a patch with a small amount of nickel on the skin to check for a reaction.
28. Laser Doppler Imaging: This imaging test measures blood flow changes in the skin following exposure to nickel.
29. Trans-Epidermal Water Loss Measurement: A tool measures the amount of water that evaporates from the skin surface. An increase in water loss may indicate nickel dermatitis.
30. In Vivo Reflectance Confocal Microscopy (RCM): RCM allows non-invasive, real-time imaging of the skin. It can help visualize changes in the skin due to nickel dermatitis.

Treatment

This allergic reaction arises from the skin’s exposure to items containing nickel. Here, we provide a detailed list of treatments for nickel dermatitis, designed to offer you relief and improve your quality of life.

1. Over-the-counter hydrocortisone creams: These creams can reduce inflammation and itching, providing immediate relief. They’re easily accessible and affordable.
2. Prescription-strength corticosteroid creams: When over-the-counter treatments aren’t enough, doctors may prescribe stronger corticosteroid creams.
3. Oral corticosteroids: For severe cases, oral corticosteroids such as prednisone might be prescribed.
4. Topical calcineurin inhibitors: Medications like tacrolimus (Protopic) and pimecrolimus (Elidel) may be prescribed for short-term relief of symptoms.
5. Antihistamines: Oral antihistamines, like diphenhydramine (Benadryl), can help reduce itching.
6. Wet compresses: Applying wet compresses to the skin can help soothe and cool irritated skin.
7. Moisturizers: Regular application of moisturizers can help alleviate dryness associated with nickel dermatitis.
8. Barrier creams: These creams provide a protective layer over the skin, reducing contact with nickel.
9. Oatmeal baths: Soaking in an oatmeal bath can help soothe irritated skin.
10. Phototherapy: This light therapy can help manage chronic, hard-to-treat nickel dermatitis.
11. Cotton gloves: Wearing cotton gloves can provide a barrier between your skin and nickel objects, especially for hand dermatitis.
12. Nickel-guard coatings: Using nickel-guard coatings on commonly used items can minimize skin exposure to nickel.
13. Nickel-free jewelry: Opting for nickel-free jewelry can help prevent allergic reactions.
14. Cool showers: Taking cool showers instead of hot ones can help alleviate symptoms.
15. Nickel-free diet: Some foods contain nickel, so following a nickel-free diet might help manage symptoms.
16. Avoidance of nickel: The best way to prevent Nickel dermatitis is to avoid contact with Nickel altogether.
17. Allergy shots (Immunotherapy): Immunotherapy may be a viable option for individuals with severe nickel allergies.
18. Non-rubber gloves: Using non-rubber gloves for chores can protect your hands from nickel-containing objects.
19. Cotton clothing: Wearing cotton clothing can prevent the irritation of sensitive skin.
20. Disulfiram: Disulfiram, a medication generally used for treating alcohol dependence, has also shown some potential in treating nickel dermatitis.
21. Nickel-spot test kits: These kits can help you identify items in your home that contain nickel.
22. Zinc supplementation: Some studies suggest that taking zinc can help treat nickel dermatitis.
23. Patch testing: This identifies what substances might be causing your allergic reaction, helping you avoid them.
24. Aloe Vera: Aloe Vera gel has natural soothing properties and can provide relief from itching and inflammation.
25. Vitamin C: Some evidence suggests that high-dose vitamin C can reduce skin inflammation.
26. Cold compresses: Cold compresses can reduce inflammation and numb the area, providing relief from itching.
27. Tea tree oil: Tea tree oil’s antiseptic properties can help heal skin and reduce inflammation.
28. Flaxseed oil: Flaxseed oil, rich in omega-3 fatty acids, can help reduce inflammation.
29. Quercetin supplements: Quercetin, a natural plant pigment, can help curb inflammation and allergic reactions.
30. Bleach baths: A diluted bleach bath can help kill bacteria on the skin, reducing itching and redness.

Medications

Drug treatments for nickel dermatitis.

1. Topical Corticosteroids: Known for their potent anti-inflammatory properties, topical corticosteroids like hydrocortisone and betamethasone are among the first-line treatments for nickel dermatitis. They reduce inflammation, itching, and redness, offering quick relief.
2. Oral Corticosteroids: In more severe cases, oral corticosteroids such as prednisone may be prescribed. While incredibly effective, these drugs are typically used for a short duration due to potential side effects.
3. Topical Calcineurin Inhibitors: Drugs like tacrolimus and pimecrolimus inhibit the activation of immune cells in the skin, reducing inflammation and itching. They’re an excellent choice for those who cannot use corticosteroids.
4. Antihistamines: Antihistamines, like diphenhydramine and cetirizine, work by blocking histamine, a compound that the body releases during an allergic reaction. They can help control itching, making them a valuable addition to nickel dermatitis treatment.
5. Emollients: Emollients are moisturizers that help soothe the skin, reducing dryness and itchiness, which are common symptoms of nickel dermatitis. Examples include petroleum jelly and dimethicone.
6. Barrier Creams: Creams containing dimethicone or other silicone-based polymers can provide a protective barrier on the skin, reducing direct contact with nickel and helping manage symptoms.
7. Oral Antioxidants: Certain oral antioxidants, like vitamins C and E, have shown some promise in helping manage nickel dermatitis, potentially due to their anti-inflammatory properties.
8. Desensitization (Hyposensitization): Under medical supervision, gradually increasing doses of nickel may be introduced to desensitize the immune system. This is a long-term treatment option for severe, persistent nickel dermatitis.
9. Phototherapy: While not a drug, phototherapy uses controlled exposure to specific wavelengths of light to alleviate skin inflammation, and can be used in conjunction with medications for nickel dermatitis.
10. Oral Antibiotics: In cases where the skin becomes infected due to scratching, oral antibiotics like amoxicillin or doxycycline may be prescribed to clear the infection.
11. Topical Antibiotics: Topical versions, like mupirocin, can be applied directly to the infected area, preventing the spread of bacteria.
12. Immunomodulatory Agents: For severe or refractory cases of nickel dermatitis, immunomodulatory agents like azathioprine or cyclosporine may be considered, though they are usually a last resort due to their significant side effects.
13. Leukotriene Inhibitors: Drugs like montelukast are used to control allergic reactions, including nickel dermatitis. They work by inhibiting leukotrienes, chemicals that promote allergic reactions.
14. Disulfiram: Though traditionally used for treating alcohol dependence, disulfiram has been used off-label to manage severe cases of systemic nickel allergy syndrome, a more generalized allergic reaction to nickel.
15. Chelation Therapy: Certain chelating agents like EDTA can bind to nickel in the body and help remove it. This therapy should only be used under the strict supervision of a healthcare professional.

Always remember, your healthcare provider is the best source of information for your individual situation. Before starting any new treatment, ensure to discuss it with your healthcare provider. By keeping this comprehensive list of treatments at your fingertips, you are equipped to manage your nickel dermatitis effectively, while maintaining a healthy and happy lifestyle.

Remember: nickel dermatitis is a common skin condition, and with the right treatments and prevention strategies, it’s manageable. Here’s to a life free of skin irritation!

References