Metal Allergy

Symptoms

Local skin reactions such as itching, inflammation, redness, and blistering occur acutely, especially at the sites of contact with the trigger. In the chronic stage, dry, scaly and cracked skin is often observed, e.g. in the form of chronic hand eczema. Affected areas include the hands, abdomen and earlobes. The rash can also appear secondarily on skin areas that have not come into direct contact with the metal. Metals are a typical cause of allergic contact dermatitis and may also cause systemic disease, for example, oral intake with food. Dyshidrotic eczema is associated with metal allergy. It manifests as itchy blisters on the hands (or feet) that are filled with fluid.

Causes

Metals are among the most common chemical elements in the periodic table, in which they are found on the left. About 80% of the elements belong to the metals. In our civilized world, we regularly come into contact with metals, for example, in the form of coins, door traps, tools, scissors (e.g., hairdressers), keys, watches, jewelry (e.g., earrings, necklaces, bracelets), leather (contains chromium), food (e.g., cocoa, chocolate, dried fruit – nickel), paints, piercings, zippers, buttons on the clothes, smartphones, implants and prostheses. The main metals that can cause allergy include:

  • Nickel (Ni), e.g., nickel sulfate (NiSO4) – most common trigger.
  • Cobalt (Co), e.g., cobalt dichloride (CoCl2)
  • Chromium (Cr), e.g., potassium dichromate (K2Cr2O7)

More:

  • Gold (Au)
  • Palladium (Pd)
  • Aluminum (Al)

It is a delayed and cell-mediated allergy type IV. Several factors favor the passage of metal ions into the skin. These include, for example, skin diseases, close and prolonged contact, moisture, sweat, acids and occlusion. It is estimated that up to 19% of the population is affected by a metal allergy (!) Women are much more frequently sensitized than men, presumably because they often wear contaminated earrings as children. In some cases, even higher values are found in the literature.

Diagnosis

Diagnosis is made in medical or specialist care on the basis of the clinical picture, localization, physical examination, patient history, and with an epicutaneous test.

Non-drug treatment

  • Avoid contact with allergens, wear PVC gloves.
  • Apply protective creams.
  • Test items such as jewelry for nickel. In pharmacies and drugstores, appropriate tests are available (eg Teomed, nickel). A test for nickel can be performed with the chemical dimethylglyoxime.
  • Buy hypoallergenic jewelry.
  • Apply a protective coating on the items (eg Nickel Guard).
  • Avoid foods with high nickel content.
  • Hyposensitization with oral nickel is described in the literature.

Drug treatment

Topical glucocorticoids (dermocorticoids):

  • Such as mometasone furoate or hydrocortisone acetate, have antiallergic, antiinflammatory, and immunosuppressive properties and are usually applied once daily. They are not suitable for uninterrupted continuous therapy.

Antihistamines:

  • Are administered locally, for example, as a gel (eg, dimetinden maleate) or systemically, for example, in the form of tablets (eg, fexofenadine, cetirizine). They cancel the effects of histamine, which is involved in the development of symptoms.

Cardiospermum ointments:

  • Have skin-nourishing, anti-inflammatory and anti-itch properties and are used as a herbal alternative to cortisone creams.

Skin care products:

  • Hydrate and regenerate the skin and rebuild the disturbed skin barrier.

Protective ointments:

  • Are applied to impede or prevent the passage of metal ions into the skin. They are also combined with complexing agents.

Complexing agents:

  • Such as clioquinol, disulfiram and EDTA complex the metal ions and prevent them from penetrating the skin or body. According to the literature, they are effective, but the tolerance is insufficient, especially in systemic treatment.

Ectoin:

  • Has cell-protective, anti-inflammatory, nourishing and membrane stabilizing properties. It is applied locally as a cream.

Topical calcineurin inhibitors:

  • Such as tacrolimus and pimecrolimus are also immunosuppressive and anti-inflammatory. They are used off-label because they are not approved for this indication.

Systemic therapy: