Nickel Allergy

Nickel allergy is one of the most common causes of allergic contact dermatitis. In affected individuals, dermatitis, also called eczema, develops at body sites that were in contact with nickel-containing metals.

Earlobes (from earrings), the lower abdomen (from jeans studs), and wrists (from watch straps) are the most common sites for nickel dermatitis. Affected areas may be itchy, red, and blistered, or dry, pigmented, and thickened.

Allergic contact dermatitis to nickel may affect anyone at any age. Once a nickel allergy has developed, it can last for many years, often a lifetime. The degree of allergy also varies. Some individuals can develop dermatitis from brief contact with nickel-containing items, while others may develop a reaction after many years of regular contact with the skin.

It remains a debated question among dermatologists whether nickel allergy can affect areas not in direct contact with metal. Some individuals may develop intermittent or persistent eczema called pompholyx eczema, or dyshidrotic hand dermatitis, characterised by blisters on the hands and feet. While contact with nickel-containing objects may be a contributing factor, clear causes are often absent. Some evidence suggests that, for individuals with a nickel allergy, pompholyx may be triggered by the consumption of nickel through the diet.

Nickel allergy is diagnosed through clinical history and a specific skin-allergy test called patch testing.

Nickel dermatitis can be treated with various methods. Topical steroids may be prescribed. Emollients should be applied frequently to soothe the skin and relieve itch and dryness. Antibiotics may be prescribed in cases of secondary infection. Desensitisation through injection or oral medication is not currently possible, meaning the allergy may persist for a prolonged period.

Avoiding Nickel in Everyday Life

Avoidance of skin contact with nickel-containing materials is extremely important in managing the condition.

Jewellery

Jewellery such as earrings, necklaces, rings, and watch straps may contain nickel. Nine-carat gold and white gold also contain nickel. Hypoallergenic stainless steel, solid gold (greater than 12 carats), and silver jewellery are the safest options for individuals with nickel allergy.

Clothing and Accessories

Metal zips, suspender clips, hair pins, bra hooks, and studs can contain nickel. Substitutes with coated or painted metal, or those made of plastic, are recommended.

Personal Items

Nickel can also be found in personal items such as powder compacts, lipstick holders, cellphones, razors, and keys, all of which may contact the skin and cause dermatitis.

Kitchen and Household Items

Kitchen utensils, cutlery, metal teapots, needles, and torches are among the household items that may contain nickel. Tools with plastic handles are recommended to reduce exposure. Stainless steel is a safe alternative, provided it is not nickel-plated.

Coins and Currency

Silver-coloured coins contain cupro-nickel. Cashiers with nickel allergy may develop hand dermatitis from handling these items. Wearing gloves while handling money, or paying by credit card, is recommended.

Workplace Items

Nickel may be present in workplace items such as paper clips, instruments, and chainsaws.

Low-Nickel Diet

Patients with severe contact allergy to nickel may be advised to follow a low-nickel diet. Although nickel cannot be completely eliminated from the diet, certain precautions can reduce exposure. Nickel-plated utensils and metal cooking pots should be avoided. It is also advised to avoid drinking the initial flow of water from a metal tap.

Foods to Avoid

• Canned foods, especially baked beans and canned spaghetti
• Canned fruit and dried fruit
• Oatmeal, nuts, cocoa, drinking chocolate, and chocolate
• Green beans, broccoli, peas, and soya beans

Permitted Foods

• Cereals, pasta, bread, and flour
• Most fish, dairy products, and vegetables
• Bananas, and occasional apples or citrus fruit in raw or stewed form

Avoidance of nickel-containing metals in everyday life generally relieves symptoms. In some cases, symptoms may become persistent and progress to a chronic condition, particularly if inadvertent low-dose exposure continues.