Hide and Seek: Hidden Causes of Nickel Allergy

by Audrey Kunin, MD

Posted on | By Audrey Kunin, MD

Nickel allergy is a common reaction to minute amounts of nickel particles coming into direct contact with the skin and may include jewelry, watches, zippers, snaps and even eyeglasses. Approximately 10% of Americans have an allergy to nickel. Certain occupations result in habitual nickel exposure, which increases the risk of developing a nickel allergy. These include metal factory workers, hairdressers, tailors and restaurant workers.

Jewelry Not a Girl's Best Friend?

Because women tend to wear more jewelry, particularly costume jewelry which has a high nickel content, they are more commonly affected. Men rarely present with a nickel allergy unless developed through occupational exposure. A nickel allergy may arise at any age, and as with any form of allergy, the more often the exposure, the higher the risk for developing an allergy. As seen with other medical allergies, once a person is allergic, they are always allergic.

Eczema patients (or those with atopic dermatitis or other forms of chronic open skin rashes) are more prone to developing a nickel allergy as the nickel particles can gain better access to entering the bloodstream. Also, if nickel comes in contact with an open wound, this can act as a source of sensitization. Ear, nose and body piercings can ironically act as a major form of nickel sensitization. Use of stainless steel, medical plastic or medical titanium earrings are vital during the ear piercing process to reduce this risk.

Acting Rashly

Why does a rash form from exposure to nickel? Nickel sulfate is considered foreign by the immune system – much like the body would react to a germ. When one of these foreign substances comes into contact with the skin, the body reacts, causing a rash termed an "allergic contact dermatitis." There are many causes of allergic contact dermatitis but they share clinical similarities in the appearance of the rash. Inflammation leads to itching, redness, rough scaly areas, cracking and perhaps weeping or blistered skin.

Repeat insults result in repeat flare-ups. This explains why the earlobes for instance may only develop an itchy rash periodically when certain high-risk earrings are worn versus continuous daily problems with a wedding ring.

Article written by Audrey Kunin, MD