Nickel Earlobe Dermatitis – persistent sensitivity!
Nickel Earlobe Dermatitis
Original article:
Thomas L. Watt and Robert R. Baumann. (1968). Nickel Earlobe Dermatitis. Archives of Dermatology, vol. 98: p. 155-158.
Reviewed by Brittanya Limone, BS, MA. MSIII, Loma Linda University.
- Although nickel is not a high potency sensitizer, increased frequency of nickel exposure, especially amongst young women, make it a common cause of allergic contact dermatitis.
- The development of nickel sensitization can result in persistent sensitivity despite avoidance of items containing the metal. In addition, some patients may later have negative nickel patch testing but continue to have a dermatitis that stemmed from the nickel allergy.
- Following repeated exposures, early nickel intolerances can eventually lead to metal rejection across the skin’s surface. This may lead to secondary site dermatitis reactions or a generalized dermatitis in some patients.
- Watt and Baumann conducted a year-long observational study in 17 young women after they developed a draining ear lobe dermatitis 2-4 weeks after having ear lobe piercings with implanted earrings.
- All of the women developed a positive eczematous reaction to nickel patch testing. Eleven had a personal history of atopy and three carried a family history.
- Previously, the patients had tolerated nickel exposures to costume jewelry and clothing fasteners without trouble. The nickel allergy was only apparent following the earlobe piercing.
- “In our experience, nickel sensitization following earlobe piercings is commonly mistaken for chronic infection, even though a similar dermatitis of the nonpierced earlobe is considered to be a cardinal sign of nickel allergy”.
- The study found that despite the common perception that nickel dermatitis occurs more frequently after wearing “inexpensive” jewelry, nickel dermatitis was just as readily observed in these women following exposure to 14-karat gold and sterling silver earrings as with the inexpensively plated jewelry.
- The study concluded that nickel earlobe dermatitis was highly associated with a personal history of atopy. Therefore, determination of a prior history of nickel allergy and atopy must be conducted prior to earlobe piercings.
- Of note, careful screening for “latent atopics” must also be performed as they are equally susceptible to nickel earlobe dermatitis. These individuals may never have an obvious atopic disease but have a positive family history, positive skin testing, physical signs suggesting atopy, and bear atopic offspring.
- According to Watt and Baumann, a history of nickel allergy is an “absolute contraindication” to earlobe piercings. On the other hand, personal history of atopic disease only requires warning patients about the possibility of nickel sensitization.
