Nickel allergy is commonly seen as a type of allergic contact dermatitis. It occurs in response to the exposure of the human body to the nickel element. Nickel is found commonly in the form of ornaments worn by women like earrings, nose pin, ring, anklet, nickel-coated accessories, zippers, buttons, etc.
Nickel allergy presents as an allergic response which could be caused due to a wide variety of diseases, so it is very difficult to diagnose on its first presentation. The allergic symptoms create suspicion for it and are commonly detected by the physician clinically. Since the allergic contact dermatitis is most commonly seen with the nickel allergy, so it makes it as the main culprit responsible for the skin inflammation. (1)
How To Diagnose Nickel Allergy?
For the diagnosis of nickel allergy, it is important to elicit the same response in the patient with the nickel exposure and it would also confirm the diagnosis. It is done by a test known as a patch test. In this test, the person is exposed to a number of common antigenic substances responsible for allergic contact dermatitis in very minute quantities in the pits of a membrane that is stuck to the skin. The site of attachment of the page is usually at the back which prevents interference with the daily routine. It is checked at specific intervals for the response of the allergy and its signs. The usual days for checkup are day two, day four and day seven of the attachment. Day 4 is the best reading for the test and the nickel allergy is also detected on this reading if present. For the weakly positive response, a repeat open patch testing can be done because sometimes the response is aggravated by the exposure to air and therefore can present as good allergic response sufficient enough for the diagnosis.
What Is The Best Medicine For Nickel Allergy?
Sometimes the history of nickel exposure is present but it is not known that the quantity is either sufficient to cause an allergy or not. In such cases, a test known as the dimethylglyoxime test could be performed for the diagnosis. The best treatment for nickel allergy remains its prevention. Once an allergic reaction is seen in the patient, then it is suggested to not wear the nickel-coated products. Symptomatic treatment with topical soaks of normal saline or aluminum acetate solution can be given. Lukewarm oatmeal baths are also helpful in relieving the symptoms in cases of widespread vesicular eruption. Emollients, soothing and antiseptic creams are prescribed to keep the surface moist and microorganism free to prevent superadded infection. (1)
Topical antihistaminic drugs are provided in localized symptoms whereas oral antihistaminic drugs are preferred in generalized or moderate allergic contact dermatitis. In severe cases of refractory contact dermatitis with nickel allergy, glucocorticoids and steroids are the drugs of choice because they can reduce the allergic response and inflammation very efficiently. Sometimes if the blisters become sufficiently large, therapeutic drainage could be considered without removal of the blister membrane to prevent raw surface formation.
Diagnosis of the nickel allergy is difficult because it has a presentation resembling a lot of disorders. The peculiar history given by the patient about the particular looking for the Nickel ornaments could raise suspicion towards the disorder. The diagnosis is based on a simple mechanism of eliciting an immune response in exposure to the suspected antigen. It is done by comparing various antigens at the same time in a membrane, the test is known as a patch test.
The mainstay of the treatment is symptomatic. Petroleum jellies are used as emollients in dermatitis. Topical saline application is sometimes done to relieve the itching and redness. Oral antihistaminic drugs can be given in cases that do not get corrected by topical applications. Glucocorticoid is the drug of choice for severe cases. Despite all of the treatments, prevention is the best cure.
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