Nickel allergy is a common cause of allergic contact dermatitis — an itchy rash that appears where your skin touches a usually harmless substance.
Nickel allergy is often associated with earrings and other jewelry. But nickel can be found in many everyday items, such as coins, zippers, cellphones and eyeglass frames.
You need to have a repeated or prolonged exposure to items containing nickel to develop a nickel allergy. Treatments can reduce the symptoms of nickel allergy. Once you develop a nickel allergy, however, you’ll always be sensitive to this metal and need to avoid contact.
Symptoms of nickel allergy
An allergic reaction (contact dermatitis) usually begins within hours to days after exposure to nickel. The reaction may last as long as two to four weeks. The reaction tends to occur only where your skin came into contact with nickel, but sometimes appears in other places on your body.
Nickel allergy signs and symptoms include:
- Rash or bumps: A rash or bumps may appear on the skin where it has come into contact with nickel. The rash may be itchy, red, dry, or scaly.
- Swelling: The affected area may become swollen, especially if the skin has been exposed to nickel for a prolonged period.
- Itching: The affected area may be itchy or may feel like it is burning.
- Blisters: In severe cases, blisters may form on the skin.
- Dry, cracked skin: The skin may become dry and cracked, especially if the affected area is not treated.
- Discoloration: The skin may become discolored or darkened over time.
- Allergic contact dermatitis: Nickel allergy can cause allergic contact dermatitis, which is a type of skin inflammation that occurs when the skin comes into contact with an allergen.
When do you need to see a doctor?
If you have a skin rash and don’t know how you got it, talk to a doctor. If you’ve already been diagnosed with nickel allergy and are sure you’re reacting to nickel exposure, use the over-the-counter treatments and home remedies your doctor has previously recommended.
However, if these treatments don’t help, call your doctor. If you think that skin area may have become infected, go to see your doctor right away. Signs and symptoms that might indicate an infection include:
- Increased redness on the skin
- Feel warm to the touch
- Pus in the affected skin area
Causes of nickel allergy
The exact cause of nickel allergy is unknown. As with other allergies, nickel allergy develops when your immune system views nickel as a harmful substance, rather than harmless substance. Normally, your immune system only reacts to protect your body against bacteria, viruses or toxic substances.
Once your body has developed a reaction to a particular agent (allergen) — in this case, nickel — your immune system will always be sensitive to it. That means anytime you come into contact with nickel, your immune system will respond and produce an allergic response.
Your immune system’s sensitivity to nickel may develop after your first exposure or after repeated or prolonged exposure. Sensitivity to nickel may, in part, be inherited.
Sources of nickel exposure
Common items that may expose you to nickel include:
- Jewelry for body piercings
- Other jewelry, including rings, bracelets, necklaces and jewelry clasps
- Clothing fasteners, such as zippers, snaps and bra hooks
- Belt buckles
- Eyeglass frames
- Metal tools
- Medical devices
- Laptops or computer tablets
Certain factors may increase your risk of developing a nickel allergy, including:
- Having ear or body piercings. Because nickel is common in jewelry, nickel allergy is most often associated with earrings and other body-piercing jewelry containing nickel.
- Working with metal. If you work in an occupation that constantly exposes you to nickel, your risk of developing an allergy may be higher than it is for someone who doesn’t work with this metal.
Other people who may have an increased risk of nickel allergy include metalworkers, tailors and hairdressers.
- Being female. Females are more likely to have a nickel allergy than are males. This may be because females tend to have more piercings. A recent study found that overweight women seem to have an even higher risk of nickel allergy.
- Having a family history of nickel allergy. You may have inherited a tendency to develop a nickel allergy if other people in your family are sensitive to nickel.
- Being allergic to other metals. People who have a sensitivity to other metals may also be allergic to nickel.
Prevention of nickel allergy
The best strategy to prevent a nickel allergy from developing is to avoid prolonged exposure to items containing nickel. If you already have a nickel allergy, the best way to prevent an allergic reaction is to avoid contact with this metal.
However, it’s not always easy to avoid nickel because it’s present in so many products. Home test kits are available to check for nickel in metal items.
The following tips may help you avoid nickel exposure:
Wear hypoallergenic jewelry
Avoid jewelry that contains nickel. Purchase jewelry that’s made of materials that aren’t likely to cause allergic reactions. Look for jewelry made from such metals as nickel-free stainless steel, surgical-grade stainless steel, titanium, 18-karat yellow gold, or nickel-free yellow gold and sterling silver.
Surgical-grade stainless steel may contain some nickel, but it’s generally considered hypoallergenic for most people. Be sure that your earring backings also are made of hypoallergenic materials.
Choose a body-piercing studio carefully
Choose a body-piercing studio that uses sterile, nickel-free or surgical-grade stainless steel needles in sealed packages. If that studio uses a piercing gun, check to see whether the part that touches the person getting pierced isn’t used on other customers. Check that the studio only sells hypoallergenic jewelry and can provide documentation of metal content of the products for sale.
Use substitute materials
Look for safer substitutes for common nickel-containing items:
- Watchbands made of leather, cloth or plastic
- Zippers or clothing fasteners made of plastic or coated metals
- Plastic or titanium eyeglass frames
Create a barrier
If you have to be exposed to nickel at work, creating a barrier between you and the nickel may help. If your hands have to touch nickel, wearing gloves may help.
Try covering buttons, snaps, zippers or tool handles with duct tape or with a clear barrier. Clear nail polish on jewelry may help, but may have to be reapplied often.
Diagnosis of nickel allergy
Your doctor can usually diagnose nickel allergy based on your skin’s appearance, and a recent exposure to items that may contain nickel.
If the cause of your rash isn’t apparent, however, your doctor may recommend a p8xat8xch t8xe8xst (contact hypersensitivity allergy test). The doctor may refer you to an allergy specialist or a skin specialist for this test.
During a p8xat8xch t8xe8xst, very small quantities of potential allergens (including nickel) are applied to your skin and covered with small patches. The patches remain on your skin for two days before the doctor removes them. If you have a nickel allergy, the skin under the nickel patch will be inflamed when the patch is removed or in the days after removal of the patch.
Because of the low concentrations of allergens used, pa8xt8xch t8xes8xt is safe even for people with severe allergies.
Treatment of nickel allergy
There’s no cure for nickel allergy. Once you develop a sensitivity to nickel, you’ll develop a rash (contact dermatitis) whenever you come into contact with this metal.
Your doctor may prescribe one of the following medications to reduce irritation and improve the condition of a rash from a nickel allergy reaction:
- Corticosteroid cream, such as clobetasol (Clobex, Cormax) and betamethasone dipropionate (Diprolene). Long-term use of these creams can lead to skin thinning.
- Nonsteroidal creams, such as pimecrolimus (Elidel) and tacrolimus (Protopic). The most common side effect is temporary stinging at the application site.
- Oral corticosteroid, such as prednisone, if the reaction is severe or a rash covers a large area. These drugs can cause a host of side effects, including weight gain, mood swings and increased blood pressure.
- Oral antihistamine, such as fexofenadine (Allegra) and cetirizine (Zyrtec), for relief of itching. However, these drugs may not be very effective for skin itching.
This treatment is performed by exposing your skin to controlled amounts of artificial ultraviolet light. This method is generally reserved for people who haven’t gotten better with topical or oral steroids. It can take months for phototherapy to have an effect on a nickel allergy reaction.
You may use some of the following treatments at home to treat contact dermatitis due to nickel allergy. If these treatments don’t help or the rash worsens, contact your doctor. Home remedies include:
- Use soothing lotions, such as calamine lotion, which may ease itching.
- Moisturize regularly. Your skin has a natural barrier that’s disrupted when it reacts to nickel and other allergens. Using emollient creams or lotions, such as petroleum jelly or mineral oil, could reduce your need for topical corticosteroids.
- Apply wet compresses, which can help dry blisters and relieve itching. Soak a clean cloth in tap water or Burow’s solution, an over-the-counter medication containing aluminum acetate.
Avoid certain over-the-counter ointments, such as antibiotic creams, which may contain ingredients — particularly neomycin — that can worsen an allergic reaction.
Preparing for an appointment
You’re likely to see your family doctor first if you’re experiencing an itchy rash that may be related to nickel allergy. Preparing in advance will make your appointment with a doctor more effective.
What you can do to prepare
- Write down a description of your symptoms, when they first appeared and whether they occur in a pattern or not.
- Make a list of any medications you take, including vitamins and dietary supplements.
- Prepare a list of questions.
Questions that you might want to ask your doctor include:
- What’s the most likely cause of my skin rash?
- What else might cause this skin rash?
- Is there a test that can confirm a nickel allergy? Do I need to prepare for this test?
- What are the treatment methods for nickel allergy, and which method do you recommend?
- What side effects can I expect from these treatment methods?
- Can I use over-the-counter medications to treat nickel allergy?
What the doctor may ask
The doctor is likely to ask you a number of questions:
- When did your symptoms begin?
- Have your symptoms changed over time?
- What at-home treatment methods have you used?
- What effect did those treatment methods have?
- What appears to worsen your symptoms?
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