There are many causes of contact dermatitis. But do you know the most frequent cause of contact allergy worldwide? Surprisingly, it is nickel.

Nickel allergy affects about 20% of people in the US and some studies report up to 40% prevalence in the EU and other countries.

As a physician, the biggest telltale sign is a patient who comes in with “weepy” ears. What, exactly, is a weepy ear? This refers to the dry, scaly, and sometimes oozy rashes that can occur along the earlobe or an earring hole that constantly feels raw. This often occurs from inflammation caused by even a tiny amount of nickel in an earring, in a susceptible individual.

What is Nickel?

Nickel is a commonly-used metal that resists corrosion, even at high temperatures. It is used with other metals to make “alloys” or metal mixtures. It’s an inexpensive metal that adds strength to other metals.

Where is Nickel Found?

Nickel is found in a variety of places. They include:

• Costume Jewelry: This is a category of jewelry that is not considered to be fine jewelry, often with a silver finish. Sometime costume jewelry is plated with gold or other less allergenic metals, but when the coating wears off, it can expose a metal that has nickel in it. Pure sterling silver (hard to find!) and stainless steel do not tend to be as allergenic.
• Some Fine Jewelry: There are some types of fine jewelry that are made from metals that are mixtures of multiple types of metal (this is common even for fine jewelry). Nickel can be mixed in with gold (especially white gold), platinum, and other metals which can be tricky!
• Belt buckles
• Watchbands
• Zippers
• Metal Buttons on Clothing (Accessories)
• Eye shadow or other metallized makeup
• Metal Eyeglasses
• Coins/Keys

Nickel is also occasionally found in medical and dental implants and some other dental materials (braces, metal retainers, some fillings, etc.). This may cause an implant to fail or cause inflammation that leads to swelling, pain, and other unwanted issues.

Other Allergenic Metals

There are other metals that may cause allergies and we often see these allergies co-exist with nickel allergy. They include:

• Cobalt
• Chromium
• Palladium

Alternatives to Nickel That are Less Allergenic:

Pure Gold (24 karat): Although we are starting to see people emerge with gold allergies too (sigh), gold in its purest form (24 kt) is mostly tolerated in people with nickel allergy.

Platinum, titanium, and rhodium are considered to be some of the least allergenic metals. Some jewelry can be plated with these, making it suitable to wear for nickel allergic people. However, the coating can wear off over time. This may reveal the underlying nickel and start causing reactions...so beware!

Signs of Metal-Induced Contact Dermatitis

There are several ways to recognize the contact dermatitis caused by nickel. These include:

• Red, dry, bumpy patches of skin
• Skin that is occasionally scaly
• Skin that is sometimes oozy/crusty
• “Weepy ear” - an earring hole that is itchy, oozy/crusty, and even potentially has a foul odor.

These symptoms occur where the metal has touched the skin and can be exacerbated by sweating.