Dermatologists offer tips to avoid nickel-induced dermatitis

    SCHAUMBURG, Ill., May 12 /PRNewswire/ -- For the estimated 82 percent
of women with pierced ears, earrings are an important fashion accessory
that many women wear, and change, daily. However, a new study suggests that
women may be getting more than they bargained for when purchasing
inexpensive earrings. Nickel exposure from these earrings is a common cause
of dermatitis on the earlobes and repeated exposure can make treatment
difficult.

    In the report entitled, "Nickel release from earrings purchased in the
United States: The San Francisco earring study," published online in the
Journal of the American Academy of Dermatology, dermatologist Howard I.
Maibach, MD, FAAD, professor of dermatology at the University of
California, San Francisco, presented evidence that nickel exposure from
inexpensive earrings purchased from various stores and vendors is frequent
in the United States and does not correlate with the price of the earrings
within the "inexpensive" price range.

    "Sensitization to nickel is quite common in the United States, with
studies estimating that 5.8 percent of American adults tested positive to
nickel allergy through a routine skin test," said Dr. Maibach. "In the
early 1990s, the European Union Nickel Directive was passed in an effort to
decrease the prevalence of nickel sensitization in consumer and
occupational products in Europe, with results indicating the directive is
working. However, no such regulations exist in the United States to limit
nickel exposure -- leaving millions of people at risk for dermatitis from
common goods, such as earrings."

    For the study, Dr. Maibach and his collaborator, Jacob Pontoppidan
Thyssen, MD, purchased inexpensive earrings from 34 different stores and
artists in San Francisco in October 2007. Inexpensive earrings were
classified as those under $50; in contrast, expensive earrings were
classified as those made of gold or platinum available from fine jewelry
stores. A total of 277 earrings were purchased from four different
categories of vendors -- a downtown market with licensed local artists
producing custom-made jewelry; jewelry stores in China Town targeting
mainly tourists; national and international clothing and accessory chain
stores targeting mainly girls and women under age 40; and similar stores
targeting mainly women over age 40.

    All earrings purchased were examined with the dimethylglyoxime (DMG)
test -- a routine spot test using solutions to detect the presence of
nickel and other alloys. Of the 277 earrings that were tested, 85 (or 30.7
percent) demonstrated at least one spot that tested DMG-positive for
nickel. Dr. Maibach noted that the highest proportion of DMG-positive
earrings was purchased from local artists, with 69 percent of these
earrings testing positive for nickel. A large portion (42.9 percent) of
earrings purchased from stores in China Town also tested positive for
nickel.

    When the number of DMG-positive earrings was examined from accessory
and clothing stores targeting younger women under age 40 and those stores
targeting women over age 40, Dr. Maibach found a large discrepancy.
Specifically, 24.1 percent of the earrings purchased at the stores
targeting younger women tested positive for nickel; whereas only 1.7
percent of earrings from stores targeting women over 40 tested DMG
positive.

    "Except for one store targeting girls and young women where a
significant number of DMG-positive earrings were found, the proportion of
earrings that tested positive for nickel was generally higher among
individual China Town stores and local artists than in individual national
and international chain stores," said Dr. Maibach. "We also found no
correlation between the country where the earrings were manufactured and
the frequency of DMG-positive reactions or whether the price of the
inexpensive earrings correlated with testing positive for nickel exposure."

    Dr. Maibach added that in one accessory store, none of the 44 earrings
priced between $5 and $8 were DMG positive, whereas numerous earrings
priced between $15 and $25 in another accessory store were DMG positive.

    "From our findings, we could not establish a 'safe-limit price' as a
guide for consumers who want to avoid excessive nickel exposure when
purchasing inexpensive earrings," said Dr. Maibach. "But it's safe to say
that young customers purchasing earrings at a considerable price range in
U.S. chain stores are potentially at risk of nickel exposure and
sensitization."

    Studies show that nickel sensitization increases the risk of hand
eczema, but Dr. Maibach argued that avoiding nickel -- which is found
almost everywhere -- can be difficult. He acknowledged that there are some
patients with nickel dermatitis who refuse to give up their jewelry, even
when they know it is the cause of their condition. Since the best way to
avoid nickel sensitization and subsequent dermatitis is to prevent nickel
exposure, Dr. Maibach suggested the following tips:


    -- Look for jewelry and clothing labeled "nickel-free" or "hypoallergenic"
    -- Wear only stainless steel, platinum or gold jewelry if you know you are
       allergic to nickel
    -- Discontinue wearing jewelry that causes any noticeable skin irritation,
       such as redness or itching
    -- Use 1% hydrocortisone cream or ointment, which can be purchased
       over-the-counter, to treat nickel-induced dermatitis
    -- See your dermatologist if symptoms worsen or do not improve within
       three to five days of not wearing jewelry

    Headquartered in Schaumburg, Ill., the American Academy of Dermatology
(Academy), founded in 1938, is the largest, most influential, and most
representative of all dermatologic associations. With a membership of more
than 15,000 physicians worldwide, the Academy is committed to: advancing
the diagnosis and medical, surgical and cosmetic treatment of the skin,
hair and nails; advocating high standards in clinical practice, education,
and research in dermatology; and supporting and enhancing patient care for
a lifetime of healthier skin, hair and nails. For more information, contact
the Academy at 1-888-462-DERM (3376) or http://www.aad.org.

SOURCE American Academy of Dermatology

Special from Bottom Line's Daily Health News

An allergy to nickel can arise seemingly out of nowhere. In my neighbor's case, it was a watch she had loved and worn often for years. Her wrist and arm got red and itchy and started to blister. She thought it was poison ivy, which she was also allergic to, yet her conventional treatments didn't work. It wasn't until a friend mentioned nickel as a possible cause that she tried not wearing the watch -- and the mystery rash abated. She had to retire the watch to her jewelry box and is now careful to avoid all nickel-containing substances. Other people have far worse cases -- rashes that spread and take a longer time to subside. For details on nickel allergy -- why it has become so much more common and what can be done about it, I spoke with Audrey Kunin, MD, the founder and president of DERMAdoctor (www.dermadoctor.com) and coauthor of The DERMAdoctor Skinstruction Manual (Simon & Schuster).

WHY IS NICKEL ALLERGY GETTING MORE COMMON?

Nickel allergy is one of the 10 most common causes of "allergic contact dermatitis" (inflammation, redness and itching brought on by direct contact with an allergen) and more and more people are developing it. Costume jewelry is often made with nickel, but it can be found in pricy gold and silver as well, notes Dr. Kunin. It can be difficult to avoid nickel because you don't always know where it may be lurking -- I'll provide more information on that in a minute.

Nickel allergies vary widely from one person to the next. Reactions may develop after an initial exposure but more commonly (as for my neighbor) after prolonged or repeated exposure to nickel. Once the sensitivity has developed, people may experience tingling and itching within minutes of contact with nickel, followed by a rash in the area a day or two later. Bumps and blistering may also develop.

Dr. Kunin says the reason behind the dramatic increase in the number of people with nickel allergy is that piercing -- ears, noses, belly buttons and what-have-you -- has become so popular. In one study, only 1% of schoolgirls who had no piercings had nickel allergies... while 13% of those with piercings had developed a nickel allergy. It even arises among the very traditional women who just pierce their ears, one hole on each side, since the allergy is triggered by nickel in the piercing-post. Though the sensitivity can develop from other sources, nickel allergies more easily arise with a fresh piercing because the open wound allows the metal to leach directly into the bloodstream over the several days it takes to heal, says Dr. Kunin. Though nickel allergies affect more women (as many as 15% to 30%, by some estimates) than men, it's not just a girl thing -- men get it too. Plus, Dr. Kunin says, some people who are allergic to nickel will also react to chromium and cobalt dyes (green and blue dyes) commonly used in tattoo ink.

NOT SO EASY TO AVOID NICKEL

While there's no cure for nickel allergy, most cases are fairly mild and the best strategy is simply to avoid contact. Here is a list of items that commonly include nickel...

·                     Costume jewelry (rings, earrings, bracelets, necklaces, etc.)

·                     Belt buckles

·                     Zippers, snaps, clasps and other clothing fasteners

·                     Watchbands

·                     Eyeglass frames

·                     Buttons

·                     Paper clips

·                     Pens

·                     Keys

·                     Tools

·                     Coins

·                     Certain eye creams

·                     Cigarette smoke

Orthodontia are not usually problematic, though in extremely rare cases sensitive people may react to nickel in stainless steel wires and brackets used in dentistry, says Dr. Kunin. She reassured me, though, that dental fillings, surgical staples, wires and orthopedic implants are not on the list of potential nickel allergy culprits. Since such allergies can worsen, sometimes (though only very rarely) leading to anaphylactoid reaction, people who are nickel-allergic should make sure their physician is aware of the problem prior to any treatment or procedure.

WHEN NICKEL ALLERGY IS SEVERE

A very small percentage of people who are nickel-allergic suffer from a severe form in which they may develop not only a local reaction, but a painful and itchy rash over most of the body. Some benefit from adhering to a nickel-free diet, says Dr. Kunin. Foods that contain nickel include....

·                     Chocolate

·                     Potatoes

·                     Salmon

·                     Nuts and legumes

·                     Canned fruits and vegetables

Tap water can also contain nickel, according to Dr. Kunin, but for the average individual who is allergic to nickel, this should not pose a problem. However since nickel levels are higher in hot water than in cold, terribly sensitive people should keep temperatures moderate for showering and bathing, she notes, because in theory they could react to it. Running the water for five minutes to flush out impurities (the source of the nickel comes from the plumbing) may also help.

MORE HELPFUL TIPS

Here are some other ideas that might be of use to people with nickel allergy...

·                     A helpful product to have on hand is Nickel Solution Detect & Protect ($25), which is a kit that includes both a product to detect nickel and a product that creates a barrier between jewelry and skin. DERMAdoctor carries it, as do some specialty drugstores. You can also search for allergy products on-line.

·                     Avoid nickel pierced jewelry! Use hypoallergenic, stainless steel, medical titanium or medical plastic backs. For posts, Blomdahl Medical carries titanium and medical plastic versions that are ideal for anyone with this concern.

·                     To salvage jewelry that is valuable to you, even if only because of a sentimental connection, consider having it professionally electroplated with gold. This will keep nickel particles from coming into direct contact with your skin. Electroplating deposits a very thin coating of a very pure form of gold to help provide a barrier against the nickel particles. Be aware, however, they remain present deeper in the jewelry... and the electroplating will eventually wear away and need to be redone.

·                     Keep cool and dry, especially those parts of your body that come into contact with metal. Perspiration can aggravate nickel contact dermatitis by leaching nickel particles from metal.

According to Daily Health News contributing editor Andrew L. Rubman, ND, it can be helpful to consult with an ND or other qualified professional who uses natural medicine to improve resistance to the challenge of certain metal exposures, including nickel. The sooner the better though, as the sensitivity increases and the reactions become more severe, the problem gets harder to treat. Typical strategies might include use of antioxidants (with vitamins A, C, E, Zinc, Selenium)... omega-3 supplementation... and avoiding fried foods and foods containing trans fats, all of which can reduce the intensity and frequency of reactions by increasing tissue concentration of natural anti-inflammatory substances.

As with all allergies, the best solution is to do all you can to avoid what brings on symptoms. For most people with nickel allergy, that's easy -- as much as you may like the jewelry, the rash that accompanies it is both ugly and uncomfortable. That's a higher price than anyone ought to pay for adornment.

First Printed: October 18, 2007

Audrey Kunin, MD, the founder and president of DERMAdoctor, and coauthor of The DERMAdoctor Skinstruction Manual (Simon & Schuster). Visit her Web site at www.dermadoctor.com.

Reprinted with the permission of:
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For more information about nickel allergy or Nickel Solution visit www.athenaallergy.com