Nickel allergy is caused by contact of human skin or mucous membrane with nickel. Especially women suffer very often from this contact allergy, which is usually harmless and heals within a few days without complications. However, affected patients should permanently avoid contact with nickel-containing products to avoid causing the contact dermatitis typical of nickel allergy.
What is a nickel allergy?
Schematic diagram showing the anatomy of the skin as well as the symptomatology of nickel allergy. Click to enlarge. Nickel allergy, which is very common, is an allergy that results from contact of the skin or mucous membrane with nickel or nickel-containing products. Nickel can be found, for example, in jewelry, eyeglasses, cutlery, detergents, coins or zippers. However, food and stimulants such as strawberries, cigarettes or nuts can also contain nickel and cause a nickel allergy. This is manifested by an inflammation of the skin, a so-called eczema, which often causes severe itching and a reddened skin rash. The eczema occurs only on the part of the body that has come into contact with nickel, which is typical of a nickel allergy.
Causes
One cause of nickel allergy is genetics, because this form of contact allergy is inherited in many cases. Thus, if one’s mother already suffers from a nickel allergy, the risk of also developing this form of contact allergy oneself in the course of life is significantly increased. The skin rash typical of nickel allergy is caused by a reaction of the immune system when the skin comes into contact with nickel. Very sensitive people react to even the smallest amounts of nickel, which can also be contained in food, for example.
Symptoms, complaints and signs
The reaction in a nickel allergy does not appear immediately on contact with the material, but is delayed. Only about twelve hours to three days after touching the nickel-containing object do the first symptoms begin. The metal is released from jewelry, buttons or belts by body perspiration and a so-called contact dermatitis forms on the areas touched. It is usually limited exactly to the points of contact. The skin reddens and swells, wheals, pustules and fluid-filled blisters may form, accompanied by intense itching. Scratching aggravates the skin reaction, healing is delayed and infections are possible. Nickel can also be ingested with food. The allergic reaction then manifests itself in the armpits, because nickel is excreted there through sweat. In addition, oral ingestion can cause old, already healed eczema to flare up again. If components of dental prostheses contain nickel, changes appear on the oral mucosa. Chronic contact eczema develops when nickel is touched permanently or frequently. The skin becomes inflamed, thick and horny. Scales and painful cracks may form. In very rare cases, the skin symptoms spread over the whole body. This is called generalized contact dermatitis, which is often accompanied by nausea, vomiting and fever.
Diagnosis and course
If a patient presents with nickel allergy, the attending dermatologist will first ask about the patient’s history. In most cases, the physician can make a tentative diagnosis of nickel allergy based on the patient’s narrative and the characteristic eczema. To confirm this diagnosis, it is possible to carry out an allergy test, the so-called epicutaneous test. This detects whether a nickel allergy is present in the affected patient. A nickel-containing substance is applied to the skin under a plaster and the skin’s reaction is observed. If this shows the typical symptoms of a contact allergy, i.e. contact eczema, the diagnosis of a nickel allergy is confirmed. In most cases, a nickel allergy does not pose a major health risk, provided that contact with nickel is permanently and consistently avoided. Only in very rare cases can a nickel allergy develop into a chronic eczema that must be treated with special medications or forms of therapy. Complications are only to be expected if contact with nickel is not permanently avoided, for example if the patient’s dental implants contain nickel.In these, very rare cases, it is imperative to remove the nickel-containing products as soon as possible to rule out severe complications of nickel allergy.
Complications
Without treatment, nickel allergy can lead to permanent skin changes. After initial formation of nodules and blisters, the skin begins to ooze. Redness occurs and purulent pustules form. There is increased formation of scales, the skin tears and can thicken in places with inflammation, sometimes becoming keratinized. The scratching of the skin as a result of the itching that occurs has a negative effect on the local inflammation and leads to further infections. The allergic reaction can thus spread to other areas of the body. Deeper scratched skin tends to form scar tissue. The susceptibility of the affected skin to infestation with fungi and bacteria increases. In addition, severe itching is a psychological burden for those affected. Complications are possible if the allergy is caused by a nickel-containing prosthesis in the body. Thus, a dental prosthesis as a trigger can lead to a mucosal change in the mouth. During treatment with cream, lotion or ointment, there may be a short-term deterioration of the skin condition. If prescribed cortisone ointments are used for too long, side effects may occur in the form of thinning of the skin and hyperpigmentation. Disturbances in the healing process of the skin may occur due to the use of products unsuitable for personal care, which cause burning and tightening of the skin.
When should you go to the doctor?
Nickel allergy is not uncommon, but the layman likes to equate it with intolerance to the material. This is even more common, many people are sensitive to nickel. In the case of such a reaction, the doctor should be consulted at the first occurrence, because it must be clarified whether the skin merely reacts sensitively or whether it is actually a nickel allergy. In the case of an allergy, it is possible that other allergies are also present. These can be tested for right away so that the affected person can avoid contact with possible further allergens in order to avoid having to struggle with symptoms in the first place. On the other hand, the affected person must know about the allergy so that he can protect himself from contact with nickel in the future. Especially inexpensive jewelry must be paid close attention to in case of known nickel allergy. If skin or other contact with nickel has occurred in the case of a known nickel allergy, a visit to the doctor is advisable if the reaction to it is either particularly severe or if there is an unusual reaction of the body that the person affected has not experienced before. Often the case occurs that the affected person notices only after a few hours of wearing that there must be nickel in a piece of jewelry.
Treatment and therapy
In the case of nickel allergy, the first treatment step is to avoid contact with the allergy-causing substance. Patients should completely avoid nickel-containing products and also be careful not to consume nickel in their diet. However, the effectiveness of a nickel-free diet cannot be proven conclusively. If there is no significant improvement in the patient’s condition within a quarter of a year, the nickel diet can be discontinued. If contact dermatitis develops as a result of a nickel allergy, the dermatologist usually prescribes an anti-inflammatory ointment or cream for his patients, which at the same time also reduces itching and has a soothing effect on the skin. There is also a choice of preparations that have an anti-allergic effect and support the skin in healing the eczema. It usually takes only a few days for the skin to recover from contact dermatitis caused by a nickel allergy.
Outlook and prognosis
Once a nickel allergy has been diagnosed, this condition will persist indefinitely. A cure is not possible, but the prognosis for an uncomplicated course is good. From the time of sensitization, a symptom-free life is possible if affected individuals refrain from contact with nickel. Complaints and symptoms normally disappear within two to three weeks. It is therefore all the more important to consistently follow a low-nickel diet for a period of at least two to three months.However, if the symptoms persisted for a longer period of time due to the allergy, the affected areas of the skin may be particularly susceptible to bacterial or fungal infection. There is a noticeable feeling of warmth, severe redness, and swelling or pain. Medically prescribed treatment of the infection is urgently indicated, depending on the pathogen. Therefore, it is necessary to always inform the attending physician about the presence of nickel allergy. In addition, nickel allergy sufferers should be aware that a rejection reaction may occur if a bone fracture has been treated by means of surgical metal restoration. In the occupational field, a nickel allergy can also have an effect. It does not matter if there is a frequent contact with water or a comparable straining of the skin surfaces. A spreading of the nickel allergy and further contact allergies can be the consequence.
Prevention
People with a family member suffering from nickel allergy should definitely avoid products containing nickel. In this way, they can avoid the onset of a nickel allergy. If nickel allergy is already known, affected patients should avoid contact with nickel-containing substances to prevent contact dermatitis, which is typical of nickel allergy.
Follow-up
One of the purposes of aftercare is to prevent the recurrence of the disease. This is possible in the case of nickel allergy, but does not primarily fall under the responsibility of a physician. Rather, patients must avoid nickel-containing objects on their own. As a result, the typical symptoms do not occur. Those affected thus lead a symptom-free life. Such a precautionary measure is sufficient, especially in mild forms of the disease. In addition, aftercare may also require permanent treatment. Patients then often have to take cortisone in tablet form. The doctor and patient agree on regular follow-up. In addition to a detailed discussion of the symptoms, the body skin is examined for damage. This is because inflammations usually form on it. Damage to the natural skin barrier makes it more susceptible to a reaction. In the case of a severe illness, a low-nickel diet is sometimes recommended. However, this should only be done in consultation with the doctor. Under certain circumstances, complications can be contained by a diet. The personal responsibility for an allergy is usually very high. Many unwanted reactions occur in everyday life. Therefore, the patient should check his or her environment for nickel-containing substances as part of follow-up care. In addition, protective measures such as gloves should be available. The attending dermatologist will provide behavioral advice on this upon request.
What you can do yourself
For people who are affected by a nickel allergy, there are some ways in everyday life to alleviate the discomfort – however, sensitization to the product will last a lifetime. First, of course, any contact with nickel should be avoided. It is important to note in which areas nickel may be used. The substance may be present in costume jewelry or eyeglass frames. But nickel may also be present in clothing, for example in bra straps or jeans buttons. What those affected are often not aware of is that nickel can also be present in gold jewelry – even if only in small amounts. Therefore, gold jewelry is only a problem for a small proportion of nickel allergy sufferers. The use of tobacco should be avoided by sufferers at all costs. Tobacco smoke can significantly aggravate the symptoms of the disease or even cause them to develop in the first place. This rule also applies to passive smoking. People allergic to nickel should therefore avoid places where smoking is permitted. It is also helpful to take good care of the skin. Moisturizing creams or oils are recommended here.
