Patients at risk:
(1) young females
(2) history of atopy
Sources of exposure:
(1) skin contact
(2) inhalation
(3) ingestion, especially in food
(4) infusion of intravenous fluids
Types of skin contact:
(1) jewelry
(2) buckle, snap
(3) watch band
(4) stainless steel surgical clips
(5) groundwater
(6) industrial dust
Signs of skin contact:
(1) localized dermatitis, often eczematous, sometimes with vesicles
(2) often in the pattern of the inciting object
Signs of systemic contact:
(1) eczematous skin rash, especially on the hands
(2) asthma
(3) urticaria
(4) pruritic dermatitis
(5) erythema multiforme
Skin patch testing to nickel is positive.
Reversal of the findings on removal of nickel exposure supports the diagnosis. However, since nickel contamination of food, water and metals is common, total elimination can be a challenge.
