Interactive Quiz: Abdominal Rash
Answer: C, Nickel, cobalt, chromium
Metal allergy is an environmental disorder that is provoked by increased cutaneous exposure to metal ions. Nickel, cobalt, and chromium are the 3 most prevalent metal allergens. Cutaneous symptoms of metal allergy usually appear within 24 hours up to days after exposure.3 The occurrence rate of metal allergy is high in the general population, with approximately 17% of women and 3% of men being allergic to nickel, and 1% to 3% of both sexes being allergic to cobalt and chromium.6 The recurrence rate of Ni-ACD is dependent on exposure, and sensitization is lifelong.
In our patient’s case, the sensitization was evoked by the exogenous allergen, nickel. The nickel from a belt buckle entered the epidermis through a compromised skin barrier at the patient’s waistband. Sweat and friction increased the release of nickel and the patient’s sensitivity to it.
The aim of Ni-ACD treatment is accurate diagnosis, avoidance, and prevention.3 First-line treatment is avoidance of the nickel allergen,7 particularly among patients with atopic dermatitis, in whom the preemptive avoidance of nickel may decrease sensitization and related morbidity.3
Other ACD therapies are directed at alleviating the symptoms and preventing recurrence.2 Topical midpotency corticosteroids and antihistamines offer temporary relief of pruritus. Corticosteroid ointments contain fewer sensitizing preservatives and are recommended over creams and lotions.1 Supportive care options include cool compresses, emollients, Burow solution, calamine, and oatmeal baths.1 Established Ni-ACD treatment options include UV-B phototherapy and corticosteroids.2
Specific patient education includes complete avoidance of sources of nickel, such as buckles, buttons, clasps, and zippers on clothing; electronics (eg, mobile phones, laptops, tablets, gaming controllers, headsets); coins; keys; jewelry and piercings; foods with nickel content; musical instruments; cooking utensils; razors; eyeglass frames; dental appliances; and the possible occupational exposure. Education also includes the use of nickel-free alternatives.8
Dimethylglyoxime-ammonia spot testing is recommended for patients to test metal-containing items for nickel content prior to purchasing or wearing them.2