Nickel allergy

Your doctor can usually diagnose nickel allergy based on your skin's appearance, and a recent exposure to items that may contain nickel.

If the cause of your rash isn't apparent, however, your doctor may recommend a patch test (contact hypersensitivity allergy test). He or she may refer you to an allergy specialist (allergist) or a skin specialist (dermatologist) for this test.

Patch testing

During a patch test, very small quantities of potential allergens (including nickel) are applied to your skin and covered with small patches. The patches remain on your skin for two days before the doctor removes them. If you have a nickel allergy, the skin under the nickel patch will be inflamed when the patch is removed or in the days after removal of the patch.

Because of the low concentrations of allergens used, patch tests are safe even for people with severe allergies.

The first step in treating nickel allergy is avoiding contact with the metal. There's no cure for nickel allergy. Once you develop a sensitivity to nickel, you'll develop a rash (contact dermatitis) whenever you come into contact with the metal.

Medications

Your doctor may prescribe one of the following medications to reduce irritation and improve the condition of a rash from a nickel allergy reaction:

• Corticosteroid cream, such as clobetasol (Clobex, Cormax, others) and betamethasone dipropionate (Diprolene). Long-term use of these can lead to skin thinning.
• Nonsteroidal creams, such as tacrolimus (Protopic). The most common side effect is temporary stinging at the application site.
• Oral corticosteroid, such as prednisone, if the reaction is severe or a rash covers a large area. These drugs can cause a host of side effects, including weight gain, mood swings and increased blood pressure.
• Oral antihistamines, for relief of itching. However, these may not be very effective for skin itching.

Phototherapy

This treatment involves exposing your skin to controlled amounts of artificial ultraviolet light. It's generally reserved for people who haven't gotten better with topical or oral steroids. It can take months for phototherapy to have an effect on a nickel allergy reaction.

You may use some of the following treatments at home to treat contact dermatitis due to nickel allergy. If these treatments don't help or the rash worsens, contact your doctor. Home remedies include the following:

• Use soothing lotions, such as calamine lotion, which may ease itching.
• Moisturize regularly. Your skin has a natural barrier that's disrupted when it reacts to nickel and other allergens. Using emollient creams or lotions, such as petroleum jelly or mineral oil, could reduce your need for topical corticosteroids.
• Apply wet compresses, which can help dry blisters and relieve itching. Soak a clean cloth in tap water or Burow's solution, an over-the-counter medication containing aluminum acetate.

Avoid certain over-the-counter ointments, such as antibiotic creams, which may contain ingredients — particularly neomycin — that can worsen an allergic reaction.

You're likely to see your family doctor first if you're experiencing an itchy rash that may be related to nickel allergy. Preparing for your appointment can help you make the most of your time with your doctor.

What you can do

• Write down a description of your symptoms, when they first appeared and whether they occur in a pattern.
• Make a list of any medications you take, including vitamins and dietary supplements.
• Prepare a list of questions.

Questions that you might want to ask your doctor include:

• What's the most likely cause of my rash?
• What else might cause it?
• Is there a test that can confirm a nickel allergy? Do I need to prepare for this test?
• What are the treatments available for nickel allergy, and which do you recommend?
• What side effects can I expect from these treatments?
• Can I use over-the-counter medications to treat the condition?

What to expect from your doctor

Your doctor is likely to ask you a number of questions:

• When did your symptoms begin?
• Have your symptoms changed over time?
• What at-home treatments have you used?
• What effect did those treatments have?
• What, if anything, appears to worsen your symptoms?