Nickel allergy

Overview

Nickel allergy is an immune system reaction to nickel that usually causes an itchy rash where the metal comes in contact with the skin.

Nickel allergy is usually related to earrings and other jewelry. But nickel can be found in many everyday items, such as coins, zippers, eyeglass frames, metal toys, cosmetics, cellphones, laptops and other objects.

Nickel allergy happens after exposure to the metal triggers the immune system to act as if nickel is a harmful substance. Treatments can reduce the symptoms of nickel allergy. Avoiding nickel prevents repeat allergic reactions.

Symptoms

An allergic reaction usually begins within a couple of days after contact with nickel. Skin conditions related to nickel allergy may spread out from the point of contact. Less often, skin conditions may be more widespread on the body.

Nickel allergy symptoms affecting the skin include:

• Rash or bumps on the skin.
• Severe itching.
• Changes in skin color.
• Thickened, leathery, cracked skin.
• Blisters and draining fluid.

Allergic reactions other than widespread skin conditions are uncommon. But symptoms also may include upset stomach, nausea, headache or difficulty breathing.

Exposure to nickel from dental or medical devices touching the skin may result in damage to nearby tissues, pain or problems with the devices.

When to see a doctor

Talk with your healthcare professional if you don't know how you got a skin rash or if your symptoms are not getting better with treatments you can buy without a prescription.

If you think the area may have become infected, see your health professional right away. Signs and symptoms that might indicate an infection include:

• Swelling.
• Warmth.
• Pus in the affected area.
• Pain.

Get emergency care if you have trouble breathing.

Causes

A nickel allergy develops when the immune system reacts to nickel as if it were a harmful substance. After exposure to nickel, the immune system may trigger a reaction to nickel that can cause a rash.

After this happens, the immune system triggers disease-fighting activities wherever the body is exposed to nickel. The immune system activities that are supposed to protect the body actually harm the body's own tissues.

Sources of nickel exposure

Common items that may expose you to nickel include:

• Jewelry for piercings, rings, bracelets, necklaces and watches.
• Clothing fasteners, such as zippers, snaps, bra hooks and belt buckles.
• Eyeglass frames.
• Coins.
• Keys.
• Metal tools and kitchen utensils.
• Metal toys.
• Electronic devices, including cellphones, laptops and computer tablets.
• Medical and dental devices.
• Cosmetics.
• E-cigarettes.

A small number of people with nickel allergy may have an allergic reaction to nickel that's in foods. But the vast majority of people with nickel allergy have no reaction to nickel in foods.

Risk factors

Certain factors may increase your risk of developing nickel allergy, including:

• Having ear or body piercings. Nickel allergy is most often associated with earrings and other body-piercing jewelry containing nickel. Women have a higher rate of nickel allergy, probably because they are more likely to have piercings.
• Working with nickel-containing products or tools. If your job constantly exposes you to nickel, your risk of developing an allergy may be higher. This higher risk also is linked to work that requires getting your hands wet or washing your hands often. People at risk of nickel allergy include metal workers, hairdressers, food handlers, housekeepers and healthcare workers.

Prevention

The best strategy to prevent nickel allergy 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 the 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-, 22- or 24-karat yellow gold, nickel-free white gold, or sterling silver.

Choose a piercing studio carefully

Before getting a piercing, check to be sure the studio uses sterile, nickel-free or surgical-grade stainless steel needles in sealed packages. Check that the studio only sells hypoallergenic jewelry and can provide documentation of the metal content in 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

Use barriers to protect you from common nickel-containing items:

• Wear gloves to prevent contact with tools or products with nickel.
• Cover electronic devices with a protective barrier.
• Use a clear barrier, such as Nickel Guard, or clear nail polish to cover snaps, buttons, zippers and clasps.
• Use duct tape or iron-on patches to cover nickel on clothing.

Diagnosis

Your healthcare professional may be able to diagnose a nickel allergy based on your symptoms and a history of exposure to certain metals or other substances.

For additional tests, your health professional may refer you to a medical specialist in allergies, called an allergist, or a specialist in skin care, called a dermatologist.

Patch testing

During a patch test, tiny amounts of things that commonly cause allergic reactions, called allergens, are applied to your skin and covered with a patch. The patches remain on your skin for two days. If you have a nickel allergy, the skin under the nickel patch will be irritated when the patch is taken off or in the days afterward.

Because of the low concentrations of allergens used, patch tests are safe even for people with severe allergies.

Treatment

The first step in treating nickel allergy is avoiding contact with the metal. There is no cure because you will always have an allergic reaction when you are exposed to nickel.

Medications

Your healthcare professional may prescribe one of the following medicines to reduce irritation and improve the rash from a nickel allergy reaction:

• Corticosteroid creams are applied to the irritated skin for 2 to 4 weeks. Prolonged use of a corticosteroid cream can cause thinning of the skin.
• Nonsteroidal creams, such as tacrolimus (Protopic), may be used instead of corticosteroids. The most common side effect of tacrolimus is short-term burning or stinging. Other nonsteroidal creams include ruxolitinib (Opzelura) and crisaborole (Eucrisa).
• Oral corticosteroids, such as prednisone, treat severe or widespread symptoms. These medicines can be taken only for limited times because of serious side effects with long-term use.
• Oral antihistamines may provide some relief from itching.

Phototherapy

This treatment involves exposing the skin to controlled amounts of artificial ultraviolet light. It's generally reserved for people who haven't gotten better with topical or oral steroids.

Self care

You may use some of the following treatments at home to soothe a rash. If these treatments don't help or the rash worsens, contact your healthcare professional. Home remedies include the following:

• Moisturize regularly with creams and lotions to soothe and protect the skin.
• Use wet compresses to soothe rough or itching skin. Use an aluminum acetate or colloidal oatmeal solution on a damp cloth. These products are generally available at a pharmacy.

Preparing for your appointment

You're likely to see your primary healthcare professional if you're experiencing an itchy rash that may be related to nickel allergy. Preparing for your appointment can help you make the most of your time with your healthcare professional.

What you can do

• Write down a description of your symptoms, when they first appeared and whether they occur in a pattern.
• List any metal products that may touch your skin.
• Make a list of all medicines you take, including vitamins and dietary supplements, their doses, and the reasons for taking each.
• Prepare a list of questions for your healthcare professional.

Questions that you might want to ask your healthcare professional include:

• What's the most likely cause of my rash?
• What else might cause it?
• What side effects can I expect from treatments?
• Can I use nonprescription medicines to treat the condition?

What to expect from your doctor

Your healthcare professional is likely to ask you questions:

• When did your symptoms begin?
• Where is the rash?
• What other symptoms do you have?
• What kind of jewelry do you wear?
• What do you do for work?
• 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?