Nickel Spot Test

Nickel Allergies
Patients with a known, or who suspect they have, a metal allergy will find the following information on metal allergies, and particularly nickel sensitivity, useful in helping them to avoid nickel exposure and resulting allergic contact dermatitis (ACD).

SUSPECTING METAL ALLERGY
The metals that most commonly cause ACD are nickel, chrome and cobalt. In addition many other metals have occasionally been shown to cause ACD, although with a much lower incidence than the first three. Gold, palladium and platinum have been responsible for ACD from jewelry and sometimes industrial exposure. Many metals and metal salts are irritatimg to the skin, even in absence of ACD.

NICKEL THE MOST COMMON METAL ALLERGEN
Nickel is by far the most common metal allergen and is more often a problem in woman than in men. This is possibly related to the wearing of jewelry; especially pierced earrings. In nature, cobalt is frequently found along with nickel and therefore is frequently present in metal objects that contain nickel, either intentionally or accidentally. In addition, cobalt is commonly used in many other metal alloys and in clay and pottery. It may be present in manufacturing processes for paint, polyester resins, glass, pigments. In contrast, chromate (chrome) is not normally found in hard metal objects bust is found in the form of chromium salts which are present in cement, concrete, and similar construction materials. It is also used in tan leather goods.

The incidence of metal allergy has increased over the years, especially among young females, as the desire to pierce their ears (and noses) has increased. Across females of all ages the wearing of jewelry is most common cause of nickel allergy. In men, occupational exposure seems to be a greater risk factor and as such the hands tend to be the more affected area.

As more men pierce their ears an increase in nickel allergy has been seen among males.

DESCRIPTION OF NICKEL
Nickel is hard, strong, silver-white metal that resists corrosion and is used for electroplating and making alloys. Principal exposure is through costume jewelry (usually the inexpensive type) and other metal objects. Nickel is also known as niccolum sulfuricum.

JEWELRY DERMATITIS
The most classic presentation of metal allergy is jewelry dermatitis; among the types of jewelry, earings seem to be the greatest culprit. Presumably this is because the pieced earring actually penetrates the epidermal barrier, allowing potential exposure to tissue fluids at the time of piercing and again thereafter should trauma or infection occur. Some metal-sensitive individuals react only to earrings and are able to wear rings, necklaces, or other jewelry without difficulty. Wristwatch buckles and bands and eyeglass frames are also possible causes of metal jewelry dermatitis.

Skin discoloration that sometimes takes place on the skin under jewelry (known as black dermographism) usually results from the reaction of sulphides and chlorides in perspiration with the gold alloy. This should not be mistaken for an allergic reaction.

Symptoms may worsen during various seasons or times of increased perspiration. This occurs because sweat can cause leaching or dissolving out of metals.

EXPOSURE LIST
Nickel is found in many metallic items either electroplated or as alloy. They often have silvery appearance and include the following:
1. Costume jewelry (especially earring, silver or white gold)
2. Wearing apparel (snaps, buttons, zippers, etc.)
3. Coins and keys
4. Tools utensils and instruments
5. Metal parts of furniture
6. Batteries
7. Machinery parts
8. Metal-cutting fluids and coolants
9. Nickel plating for alloys such as new silver, Chinese silver and German silver.

SOURCES OF NICKEL DERMATITIS
Location Nickel Source
Scalp Hairpins, curlers and bobby pins
Eyelids Eyelash curler
Earlobes Earrings
Back of Ears Eyeglass frames
Sides of Face Bobby pins, curlers, dental instruments, transfer from hands
Lips Metal pins held in mouth and in metal lipstick holder
Neck Clasp of necklace and zipper
Upper chest Medallions and metal identification tags
Abdomen Metal buttons on blue jeans
Breast Wire brassiere support
Thighs Garter clasps, metal chairs, metal coins in the pockets, etc
Palms Handles of doors, handbags, metal tools or parts in workplace
Fingers Rings, thimbles, needles, scissors, coins and pens, paper clips, etc.
Wrist Watchbands, bracelets, metal buttons
Arms Bracelets
Ankles Bracelets
Top of foot Metal eyelets of shoes
Legs Zipper of boots

OCCUPATIONAL EXPOSURE Men have a greater frequency of sensitization to nickel at work than women.
Wet work tends to increase the likelihood of a sensitization. The following are listings of examples of occupations at risk and sources of possible occupational nickel exposure. Occupations at Risk Occupational Nickel Source
Metal Workers Alkaline Batterie
Electroplater Blackening zinc and bras
Hairdresser Ceramics
Nurse, medical or dental assistant Coatings (electroplating)
Tailor Duplicating fluids and fluxes (brazing)
Cook, Waitress Dyes
Cleaning person Electrical wiring
Office worker Enamel (green: nickel oxide)
Electronics worker Fuel additives
Dairy worker Hardening of fats (acts as catalyst)
Librarian Insecticides
Chemical Cleaner Magnet cores
Engine fitter Mordant in dying and printing fabrics
Locksmith Nickel alloys, nickel plating
Chemical worker Paint for glass
Electrician Pigments of wallpaper and paint
Construction worker Reagents and catalysts (plastics)

DIETARY EXPOSURE
The dietary role of nickel in metal hypersensitivity has been highly researched. However, it is not been found to be a significant contributor to ACD. The practicality of diet modification is variable, depending on the patient’s willingness to take necessary measures. It is also difficult because the nickel content of various foods can vary greatly. Additionally, the use of fresh vegetables and fruits in place of canned foods could also be beneficial, if desired. The following is a list of foods high in nickel content:

Baked Soda Cocoa/Chocolate
Gelatin Kippered herring
Nuts (walnuts, almonds, hazelnuts) Oats
Peas Red kidney beans
Rye Soya beans/legume
Tea Whole wheat

Canned foods are higher in nickel than fresh food equivalents.

PREVENTION OR AVOIDANCE OF NICKEL
The most effective means of preventing nickel sensitization would be to reduce exposure to nickel from costume jewelry, particulary earrings, and other nickel containing materials. When purchasing earrings ask for stainless steel studs in order to avoid nickel. Also in occupational risk areas protective devices (gloves, etc.) Should be used.

Examples of measures that can be taken include:
1 Ears could be pierced only with hypoallergenic surgical steel parts.
2 Avoid wearing pierced earrings if any inflammation develops.
3 Clear nail polish can be used to coat jewelry and clothing buttons. This should be repeated weekly to maintain barrier.
4 A jeweler can plate the jewelry with rhodium or platinum (not palladium)
5 Keys can be made of aluminum instead of nickel.
6 All metal jewelry or objects with which prolonged contact occurs should be tested with a nickel spot test. (CHEMO-NICKEL TEST®)

SELF-TESTING FOR NICKEL CONTENT IN METALS WITH: CHEMO-NICKEL TEST®, ” THE ONE STEP TEST KIT”
If you have a specific allergic contact dermatitis to nickel it is important that you are able to identify any objects or materials that contain nickel. There is a simple test that can can be used to make this determination. It is called CHEMO-NICKEL TEST®. This one step test contains a solution of 1% dimethylglyoxime ethanolammoniacal. The complete test kit contains A 6ml bottle of the solution, applicators and specific instruction for use.

Instructions for use:
CHEMO-NICKEL TEST®, ” THE ONE STEP TEST KIT” is simple to use: Moisten the applicator with the solution and rub in a circular motion against the suspected object for 30-60 seconds. If the rubbed location on the item turns color (pink to reddish), it indicates a positive reaction and presence of nickel in a concentration of at least 1:10,000. If there is no color change, there is no nickel present. The test chemicals do not harm the tested items.

As with all chemical based products in the household, KEEP IT OUT OF THE REACH OF CHILDREN AND STORE IT IN A COOL PLACE. Prior to subsequent use make certain that the product is not beyond the expiry date shown on the label.