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Nickel allergy
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
Nickel allergy is one of the most common causes of allergic contact dermatitis — an itchy rash that appears when your skin touches a normally harmless substance.
Nickel allergy is commonly associated with earrings and jewelry for other body piercings. But nickel can be found in many everyday items — from coins to necklace clasps, from watchbands to eyeglass frames.
Nickel allergy can affect people of all ages. You may develop nickel allergy after a single exposure to nickel or after repeated or prolonged exposure. Treatments can reduce the symptoms of nickel allergy. Once you develop nickel allergy, however, you will always be sensitive to the metal and should avoid contact.
Symptoms
If you have nickel allergy, an allergic reaction usually begins within 12 to 48 hours after exposure to a nickel-containing item and may persist for two to four weeks. The features of contact dermatitis usually appear only where your skin came into contact with nickel, but they may appear elsewhere on your body. Signs and symptoms of contact dermatitis caused by a nickel allergy include:
- Rash or bumps on the skin
- Itching, which may be severe
- Redness or changes in skin color
- Dry patches of skin that may resemble a burn
- Blisters and draining fluid in severe cases
Sweating at the point of contact with nickel may worsen the symptoms.
When to see a doctor
If you have a skin rash and don't know how you got it, talk to your doctor. Seek emergency care if the rash develops blisters or drains fluids.
If you've already been diagnosed with nickel allergy and are sure you're reacting to nickel exposure, you may use over-the-counter treatments and home remedies recommended by your doctor in the past. Call your doctor if you see no improvement in symptoms within two weeks.
Causes
An allergic reaction is somewhat like a case of mistaken identity within your body's immune system. Normally, your immune system reacts to protect your body against bacteria, viruses or toxic substances.
If you have nickel allergy, your body reacts to nickel. In other words, it's mistakenly identified nickel as something that could harm you. 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. When you come into contact with nickel, your immune system responds and produces an inflammatory response.
Your immune system's sensitivity to nickel may develop after your first exposure or after repeated or prolonged exposure.
The cause of nickel allergy is unknown, but sensitivity to nickel may, in part, be inherited (genetic).
Sources of nickel exposure
Nickel allergy is most commonly associated with earrings and other jewelry for body piercings that contain some nickel. Common sources of nickel exposure include:
- Jewelry for body piercings
- Other jewelry, including rings, bracelets, necklaces and jewelry clasps
- Watchbands
- Clothing fasteners, such as zippers, snaps and bra hooks
- Belt buckles
- Suspender clips
- Hairpins
- Eyeglass frames
- Coins
- Kitchen utensils
- Paper clips
- Pens
- Keys
- Tools, such as hammers and screwdrivers
Risk factors
Because nickel is common in jewelry, nickel allergy is most often associated with earrings and other body-piercing jewelry that contain nickel. If the first jewelry you wear after a piercing contains nickel, your body is constantly exposed to the metal during the healing time. And most people who have piercings wear jewelry every day.
People who have regular exposure to nickel on the tops of their hands, feet or abdomen while doing "wet work" — as a result of either sweat or frequent contact with water — may be more likely to develop nickel allergy. This may include, for example, bartenders or people who work in certain food industries.
If other people in your family are sensitive to nickel, then you may have a greater risk of developing nickel allergy.
Preparing for your appointment
You're likely to see your family doctor first if you are experiencing an itchy rash that may be related to nickel allergy. Because time with your doctor is limited, make preparations to make the best use of the time.
What you can do
- Write down a description of your symptoms.
- Make a list of any medications you take, including vitamins and dietary supplements.
- Prepare a list of questions.
Questions that you should be prepared to ask if necessary include:
- What is the most likely cause of my rash?
- What else might cause it?
- How can it best be treated?
- Do I need to see a specialist?
- Do I need prescription medication, or can I use over-the-counter medications to treat the condition?
- What home remedies do you recommend, and what home remedies should I avoid?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions:
- When did you first begin experiencing symptoms?
- Have your symptoms changed over time?
- What at-home treatments have you used?
- What effect did those treatments have?
- What, if anything, appears to worsen your symptoms?
Tests and diagnosis
Your doctor can usually diagnose nickel allergy based on your skin's appearance and your recent history of contact with items likely to contain nickel.
If the cause of your rash isn't apparent, however, your doctor may recommend a patch test (contact hypersensitivity allergy test). He or she may refer you to an allergy specialist (allergist) or skin specialists (dermatologist) for this test.
During a patch test, very small quantities of potential allergens (including nickel) are applied to small patches, which are then placed on your skin to check for a reaction. The patches remain on your skin for two days before being evaluated by your doctor. 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, patch tests are safe even for people with severe allergies.
Treatments and drugs
There is no cure for nickel allergy. Once you develop a sensitivity to nickel, you will develop a rash (contact dermatitis) whenever you come into contact with the metal. Once an allergic reaction to nickel exposure has begun, it will most likely continue for two to four weeks.
Medications
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 propionate (Temovate, Cormax, others) and betamethasone dipropionate (Diprolene)
- Oral corticosteroid, such as prednisone, if the reaction is severe or a rash covers a large area
- Oral antihistamine, such as fexofenadine (Allegra) and cetirizine (Zyrtec), for relief of itching
Lifestyle and home remedies
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 the following:
- Soothing lotions, such as calamine lotion, may alleviate itching.
- Wet compresses can be placed over the rash to help dry blisters and relieve itching. A wet compress can be made by soaking a clean cloth in Burow's solution, an over-the-counter medication containing aluminum acetate, or in a solution of 1 part vinegar to 16 parts water.
- Over-the-counter corticosteroids may alleviate itching and improve the condition of the rash. Talk to your doctor about how long you can safely use the product.
- Over-the-counter oral antihistamine, such as diphenhydramine (Benadryl), may be beneficial to help relieve itching.
You should avoid certain over-the-counter ointments, such as antibiotic creams, which may contain ingredients that can worsen an allergic reaction. To be on the safe side, don't use creams with names ending in "-caine" to treat contact dermatitis.
Prevention
The best strategy to prevent developing nickel allergy is to avoid prolonged exposure to items containing nickel, especially jewelry. If you have nickel allergy, the best way to prevent an allergic reaction is to avoid contact with the metal. The following tips can help you avoid nickel exposure:
Wear hypoallergenic jewelry
Purchase jewelry made of materials that aren't likely to cause allergic reactions (hypoallergenic). Look for jewelry made from such metals as nickel-free stainless steel, surgical-grade stainless steel, titanium, 18-karat yellow gold, nickel-free 14-karat yellow gold or niobium. Avoid jewelry with nickel, as well as cobalt and white gold, which may also trigger allergic reactions. (Surgical-grade stainless steel may contain some nickel, but it's generally considered hypoallergenic for most people.)
Get rid of jewelry that contains nickel or has caused an allergic reaction. Be sure that your earring backings also are made of hypoallergenic materials.
Choose a piercing studio carefully
Many states or cities require piercers to be licensed by a government health department. Contact your state or local health department to find out what rules apply to your area and be certain to choose a reputable studio with licensed piercers.
Visit a studio before getting a piercing to make sure that the piercer:
- Provides a clean, tidy, professional environment
- Uses sterile, nickel-free or surgical-grade stainless steel needles in sealed packages
- Sells only hypoallergenic jewelry and can provide documentation of metal content
- Doesn't use a piercing gun, which may not be sterile or nickel-free and may cause other complications
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
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