Dear Doctor Column, April 28, 2003

Question:

I've tried for years to wear earrings but I always break out in a rash and the itching is unbelievable. This happens frequently with bracelets and watches, too. I know this must be an allergy, but can anything be done?

Answer:

It sounds as if you have allergic contact dermatitis due to a sensitivity to metal, particularly nickel, common in costume jewelry. Nickel also is found in common, everyday items, including coins, bra fasteners, zippers, snaps, buttons, hairpins, eyeglass frames, pens, utensils, paper clips, keys, and tools.

As body piercing has become increasingly popular, cases of metal allergy have soared, according to the American Academy of Dermatology (AAD). Irritation and rashes occur in not only the earlobes, but also on the upper portions of the ears, lips, nose, tongue, navel, breasts, and genitalia. After poison ivy, metal allergy is the most common form of allergic contact dermatitis.

Symptoms of metal allergy usually occur between 6 to 24 hours following exposure to the metal and will dissipate if exposure to the allergen is eliminated. The affected skin may become red and swollen, and blisters often appear, which may break, leaving crusts and scales. Later, the skin may darken and become leathery and cracked. The rash is generally confined to the site of contact, although severe cases may extend outside the contact area, especially if the allergen is on your fingers and then transmitted to the face, eyelids, or genitals.

Although dermatologists can perform a simple skin patch test to see if you already have the allergy, there is no way to predict who will develop metal sensitivity. Once a metal allergy has developed, it never goes away; contact with objects containing the metal, usually nickel, can prompt a flare-up, especially in hot weather when sweat allows the metal ions to be absorbed more readily into the skin. Ultrasensitive people also may react to nickel-rich foods, such as fish and chocolate.

For minor irritation caused by exposure to metal, over-the-counter hydrocortisone cream will ease the itch and redness. If your skin has cracked and you have constant itching or blisters, remove the piece of jewelry right away and see your doctor who can treat the problem before an infection develops.

The AAD also reports that nickel dermatitis can occur with finer jewelry that is usually worn for prolonged periods, such as a wedding ring. If this happens, you can prevent the reaction by having the ring plated in a non-allergic metal, such as platinum.

For clothing, choose fasteners made of plastic, coated, or painted metal, or some other material. You can still wear jewelry; you just have to be selective in your choices. Make sure jewelry is either hypoallergenic, solid gold (at least 14 carat), pure sterling silver, polycarbonate plastic, or stainless steel (although it contains nickel, the nickel is so firmly bonded in the alloy that stainless steel is safe for most nickel-sensitive people). If you must wear earrings that contain nickel, protect yourself with plastic covers made specifically for earring studs. Some companies specialize in nickel-free jewelry.

Dermatologists recommend anyone interested in piercing their ears or other body parts, have it performed only with stainless-steel instruments or needles. Doctors also advise wearing only nickel-free earrings or other adornments, preferably stainless steel or solid gold, for at least 3 weeks after piercing, until the opening is completely healed. These precautions will help reduce the risk for developing a nickel allergy.

When a metal allergy is suspected, the AAD stresses that it's important to seek the medical advice of a dermatologist, especially since nickel and other common metals that tend to cause a reaction, such as cobalt and chromate, can be found in some common metal objects you may touch every day. If avoidance of an item is not possible, the dermatologist can recommend some other treatment options and lifestyle changes that may help you live and work without the itchy rash of allergic contact dermatitis.

You can find more information on the AAD Web site.