Nickel Allergic Contact Dermatitis: Identification, Treatment, and Prevention

Abstract

Nickel is a ubiquitous metal added to jewelry and metallic substances for its hardening properties and because it is inexpensive. Estimates suggest that at least 1.1 million children in the United States are sensitized to nickel. Nickel allergic contact dermatitis (Ni-ACD) is the most common cutaneous delayed-type hypersensitivity reaction worldwide. The incidence among children tested has almost quadrupled over the past 3 decades. The associated morbidities include itch, discomfort, school absence, and reduced quality of life. In adulthood, individuals with Ni-ACD may have severe disabling hand eczema. The increasing rate of Ni-ACD in children has been postulated to result from early and frequent exposure to metals with high amounts of nickel release (eg, as occurs with ear piercing or with products used daily in childhood such as toys, belt buckles, and electronics). To reduce exposure to metal sources with high nickel release by prolonged and direct contact with human skin, Denmark and the European Union legislated a directive several decades ago with the goal of reducing high nickel release and the incidence of Ni-ACD. Since then, there has been a global reduction in incidence of Ni-ACD in population-based studies of adults and studies of children and young adults being tested for allergic contact dermatitis. These data point to nickel exposure as a trigger for elicitation of Ni-ACD and, further, provide evidence that legislation can have a favorable effect on the economic and medical health of a population. This policy statement reviews the epidemiology, history, and appearances of Ni-ACD. Examples of sources of high nickel release are discussed to highlight how difficult it is to avoid this metal in modern daily lives. Treatments are outlined, and avoidance strategies are presented. Long-term epidemiological interventions are addressed. Advocacy for smarter nickel use is reviewed. The American Academy of Pediatrics supports US legislation that advances safety standards (as modeled by the European Union) that protect children from early and prolonged skin exposure to high–nickel-releasing items. Our final aim for this article is to aid the pediatric community in developing nickel-avoidance strategies on both individual and global levels.

Pediatric allergic contact dermatitis. Part I: Clinical features and common contact allergens in children

“…Nickel is the most frequently detected allergen in children worldwide, 81 responsible for 6% to 40% of positive patch tests (PPTs). 3,14,19,20,82,83 Sensitization is more common in children compared to adults, in North America compared to Europe, and in girls compared to boys.…”

“…28,29 Because of the prevalence of nickel allergy, the European Union implemented a nickel directive in 1994 to regulate the release of nickel in consumer products to less than 0.5 g/cm 2 /week. 92 Since then, the frequency of nickel allergy has declined in adults and children in Europe. 93 Cobalt is often compounded with nickel and is thus also found in metal-plated products such as jewelry, belt buckles, and zippers.…”

Nickel Sensitivity in Children Due to Using Stainless Steel Crowns: A Narrative Review

“…Investigations also indicated that 1.1. Millions of American children are potentially allergic to nickel (13). It has also been reported that 8% to 10% of children and adolescence in the European general population present nickel allergy (14); however, this prevalence was about 23.7% in the children of North America between 1994 to 2014 (15).…”

Contact Allergy to Nickel: Still #1 After All These Years

“…These scenarios usually can be diagnosed by the astute clinician without patch testing; however, the source of exposure may be less obvious if the nickel-releasing item has intermittent contact with the skin (eg, coins in the pocket, furniture hardware, personal grooming devices). 13 Other reported exposures include facial dermatitis from mobile phones, dermatitis of the ulnar hands from laptop use, and hand dermatitis from gaming controllers, [14][15][16] perhaps another reason for some to unplug.…”