Nickel Allergy

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

Who gets nickel allergy?

• Nickel sensitivity is common affecting around 5% of the population, especially in women.
• Anyone can become allergic to nickel, but most cases begin during teenage when girls in particular start to wear cheap metal jewellery. Ear piercing often starts up a nickel allergy which is why it’s more common in women than in men. As more men have their ears pierced, the number of men with nickel allergy is increasing rapidly.
• It’s possible, but much less common to become allergic to nickel later on in life. People who have been in contact with nickel for many years can become allergic to it for no reason – this can cause problems if your work involves handling nickel.
• Babies and children are rarely allergic to nickel. People with atopic eczema are no more likely to develop nickel allergy than others with normal skin.
• But if you have broken skin and you’re allergic to nickel, you are more likely to develop a rash whenever you touch anything made of it.

What causes nickel allergy?

• We don’t know why some people become allergic to nickel when others don’t.
• But, those with certain jobs are more likely to become sensitive to nickel – these include:

1. hairdressing
2. nursing
3. catering
4. cash handling
5. those handling metals.

What does nickel allergy look like?

• Many people sometimes notice a red, itchy rash under a jean stud, zip or watch strap buckle which can be due to irritation and sweat. Often this rash, called “jewellery dermatitis”, is the first sign of nickel allergy. Nickel allergy makes the skin red and itchy at first – later on tiny water blisters can appear, making the skin moist and oozy. The skin may then peel off.
• This rash can start in one place or in a number of places on the body at the same time.
• If the condition carries on for a long time the skin will dry out and become red, scaly and cracked. Any part of the body can develop an allergic rash to nickel but these are the most common areas:

1. hands
2. wrists
3. ears
4. stomach

• Normally the rash appears wherever nickel is in close contact with the skin. But it is possible for the rash to spread so that later on even areas which haven’t come into contact with the metal become red and itchy, although the it is usually worse where the skin is in contact with nickel.

• If you handle anything made of nickel, then traces of metal may remain on the fingertips and cause a rash elsewhere, such as on the eyelids or neck, if these are touched later.
• Once you have developed an allergic rash due to nickel on a particular part of the body, it’s possible for the rash to spring up again on that site whenever you come into contact with nickel, even at a different place on your body. So, you could touch nickel with your fingers, and get a rash on your ear lobes as well!
• Soon after becoming allergic to nickel, if you avoid any contact with it, the rash will clear and leave your skin looking just as before. But if the rash remains for a long time, because you didn’t realize it was due to nickel, it can become very difficult to clear up, even when you no longer are in contact with the metal. If the hands become generally affected so that a rash covers them, this can be especially difficult to clear – this is a particular problem for those who do a lot of housework, and those whose jobs involve their hands being frequently wet. Once the hands have become affected it’s really important to protect them until the skin is properly healed, otherwise they will remain sore for a long time.
• Most people realize they’re allergic to nickel because of where the rash is, for example under earrings. But if your rash is in an unusual place or really bad, the cause may not be clear. In this case your GP might refer you to a dermatologist who may carry out patch tests to see if you’re allergic to nickel.

Can an allergic rash become infected?

• Yes – if the skin becomes moist then it can become infected with bacteria.
• The same is true if the skin is chapped and broken, perhaps because of scratching – the hands are especially likely to become infected.
• If the skin becomes crusted and yellow, weeps, or smells odd, then it is probably infected, and you should see your doctor to get treatment – the rash will not improve until you do so.

What things contain nickel?

• Almost anything made from metal contains nickel, especially if it’s silver coloured. Some every day items which contain nickel are:

1. coins
2. jewellery
3. metal ornaments
4. scissors
5. pins
6. needles
7. thimble
8. press studs
9. zips
10. paperclips
11. metal wool scouring pads
12. cigarette lighters
13. filing cabinets
14. pens
15. metal typewriters
16. handles
17. taps
18. keys
19. keyrings
20. saucepans (stainless steel)
21. kitchen utensils
22. cutlery…

• As you can see it’s almost impossible to avoid nickel at home or work. But luckily, most nickel-sensitive people find a rash only comes up if they are in contact with nickel for a long time or when their skin is wet or sweaty.

Which parts of the body are most often affected?

• Any part of the body can develop a rash if something made from nickel comes into close contact with the skin.

Will I always be allergic to nickel?

• Once you become sensitive to nickel you are likely to remain so for life.
• But not everything containing nickel will necessarily bring out a rash every time:

1. If your skin is raw or broken, nickel can easily pass through the surface, and you are more likely to get a rash.
2. the same is true if your skin is damaged by being wet a lot.

• If you are sweaty and come into contact with nickel, you are more likely to get a rash – for example a red itchy patch may come up underneath your watch when you’re hot, but not when you’re cold.
• If something containing nickel is pressed very close to your skin, or rub against it, you are also more likely to develop a rash – metal studs often found on the tops of jeans and canvas trousers are more likely to cause a reddened patch if the trousers are tight fitting!
• Some women find they are more sensitive to nickel on certain days of their menstrual cycle, but this is not always the case.

Can nickel allergy be treated?

• There aren’t any medicines you can take to stop you being allergic to nickel. The main way to prevent a rash starting once you’re sensitive to nickel is to avoid coming into prolonged contact with anything made of it. This is very hard when so many things have nickel in them, but you must aim for this.
• Look closely at everything at home and at work and decide whether it is likely to be made of nickel. Anything made of wood, plastic, glass, paper, or fabric is safe, but check there isn’t a metal trim on these things.
• For anything made of metal, try to find out whether it contains nickel – if you can’t then assume it contains nickel, and avoid touching it.
• If something made of nickel is coated with paint, nail polish, lacquer or varnish, this will prevent your skin coming into direct contact with the metal. Although everything can’t be painted in this way, it can sometimes be useful. For example a bra fastener or press stud can easily be painted to protect your skin. But remember, this only works as long as the coating is complete – if it chips or flakes off, nickel will touch your skin. Some metal objects can also be covered with masking tape.
• Some metal items can be backed with material so that they can be worn. Some people wear a sweat band under their watch if it’s made of metal. Tucking a shirt into jeans so the metal stud doesn’t touch your skin is often sufficient, but if you find a rash appearing whenever you’re hot and sweaty then coat the stud with lacquer or cover it with material as well.
• Keep money in a bag, purse or wallet, rather than loose in your trouser pocket.
• Jewellery can be covered with clear nail varnish to protect your skin but this is difficult to do and may spoil it – plastic jewellery won’t cause you any problems! Watches made only from plastic, or with plastic material watch straps, are available, or else wear a fob watch instead.
• Wear cotton gloves if you need to handle anything made of nickel at home or work and rubber or PVC gloves with cotton liners for any wet work.
• If your skin becomes damaged after being in contact with nickel, look after it carefully until it is fully healed. Use a moisturiser frequently to stop the skin becoming dry and cracked, and watch out for signs of infection.
• A mild steroid cream or ointment, such as 1% hydrocortisone cream, may be prescribed by your doctor to clear up the rash and reduce itching. But only use a steroid cream or ointment for a few days until the rash clears.
• Remember – even when the rash goes away you are still allergic to nickel, so all contact with it still needs to be avoided.

I’m allergic to Nickel – can I wear gold jewellery?

• If you are allergic to nickel you are unlikely to be allergic to gold too.
• But, pure gold is not used to make gold jewellery because it’s not hard enough, so other metals have to be mixed with gold to make it stronger and more easily worked. 18– and 24- carat gold doesn’t contain nickel, so you can safely wear jewellery made from either. 9– carat gold can contain nickel so this should be avoided. Unfortunately, most jewellery is made of 9-carat gold, so be careful!
• Gold-plated jewellery and rolled gold should not be worn either. Gold plating is usually thin and wears off quickly, and nickel then comes to the surface.
• Foreign gold is made up of a different mixture of metals and so this type of gold should also be avoided.
• White gold can also contain nickel.
• Sterling silver doesn’t contain nickel so jewellery made from these metals can be safely worn.
• Stainless steel does contain nickel, but if it’s good quality it can be worn as the nickel is tightly bound to other metals and won’t be released.

Can I stop my child becoming allergic to nickel?

• There isn’t much you can do to stop anyone becoming allergic to nickel, because everyone comes into contact with it every day.
• But, ear piercing often starts off a nickel allergy, so if anyone decides to have their ears pierced, make sure the studs that are put in as the ears are pierced are either sterling silver, 18-carat gold or good quality stainless steel.
• When the holes have healed wear good quality gold earrings.

Can a special diet help my nickel allergy?

• Studies abroad have found that some people with severe hand eczema, thought to be due to nickel allergy, have improved following a nickel-free diet.
• Nickel can be released into food if anything acidic (rhubarb, apples, citrus fruit) is cooked in a stainless steel saucepan. Canned foods also contain nickel.
• Many foods, such as leafy green vegetables, naturally contain nickel, which makes this diet a difficult one to follow. More research needs to be done on this subject before we can be sure whether hand eczema really is helped by this diet.
• If you are considering modifying your diet to try to improve your skin, always consult your doctor first.

Conclusions

• Once you have become sensitive to nickel you are likely to stay like that for life.
• But, many people find that they are not so sensitive as time passes. If you can’t handle anything containing nickel now, even for a very short time, you may become more tolerant to the metal in future, when perhaps you will only need to avoid cheap metal jewellery.

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

National Skin Centre. Singapore