Nickel is one of the most common metal in the environment and therefore very difficult to avoid. Nickel in contact with your skin may result in dermatitis. Nickel is one of the most common allergen causing Allergic Contact Dermatitis (delayed-type hypersensitivity). About 5% of the general population of most Western Countries are allergic to Nickel. Patch Test clinics throughout the world have a high prevalence of nickel sensitivity, in the range of 15% with a significantly rising prevalence in some countries approaching 30% to 40%. This is undoubtedly related to ear and body piercing.

Nickel is found in most metal and metal plated objects such as:

The diagnosis is usually obvious from the history. Occasionally patients present with atypical features e.g. eyelid eczema or a Patch test is necessary to make this diagnosis. Nickel is included in all standard patch tests.

The most effective way of preventing nickel sensitisation would be to reduce exposure to nickel in costume jewellery, particularly earrings. Some countries have banned metal objects (including earrings, necklaces, bracelets) that release nickel in excess of 0.5mg/cm² per week. The dimethylglycoxime test is a rapid, easy method to determine the release of nickel from metal objects. Two drops of the solution is placed on a cotton swab and rubbed evenly against the item for 30 seconds. The appearance of a light pink to red on the swab indicates the release of enough nickel to cause allergic contact dermatitis.

Clioquinol ointment 3% appears to be an effective barrier to prevent nickel dermatitis

Aluminium, stainless steel and yellow gold are usually safe alternative metals.

Look for clothing with non-metallic zippers and fasteners etc.

Use scissors, kitchen utensils, combs or other metal items with plastic or wood handles.

Never wear earrings that are not guaranteed to be free of nickel.

Metallic items that are difficult to avoid contact with such as watches, door keys, etc, could be coated with several layers of nail polish or lacquer or a plastic coating to cover the metal.

If you are severely allergic use aluminium kitchen utensils and avoid foods that are rich in nickel.

Minimise wet work without protective clothing as moisture increases the penetration of nickel into skin

Like any other cause of Allergic Contact Dermatitis avoidance is the best treatment, after prevention.

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