Allergic Contact Dermatitis: Early Recognition and Diagnosis of Important Allergens

Sharon E. Jacob; Tace Steele


Dermatology Nursing. 2006;18(5):443-439, plus 4. 

In This Article


Metal allergy can present in the form of vesicles, eczematoid plaques, or lichenified plaques. Classically it is seen in the distribution of the contact with the metal product itself, such as a jeans snap or school chair. However, once sensitization has occurred, challenge and the ensuing inflammatory response can be triggered by a myriad of minor contactant exposures from food sources to multivitamins and metallic objects. As contact dermatitis is a dose-dependent phenomenon, each exposure adds to the cumulative dose (Friedmann, 1990).

Nickel is the number one allergy internationally (Saripalli, Achen, & Belsito, 2003). Nickel is found in a wide variety of places from jean snaps to costume jewelry, surgical instruments, medical chart clips, and coins. Nickel is also high in certain foods such as chocolate, soy, and asparagus (Flyvholm, Nielsen, & Andersen, 1984). The second most common metal allergy of special note is gold (Marks, Belsito, & DeLeo, 2003). A dermatitis to this metal is becoming more common as cultural practices change, such as piercing infants' ears. Gold leaf is added to some baked goods, as well as Goldschlager liquor.

Cobalt is the third highest instigator of metal allergy (Marks et al., 2003). It is found in dental amalgams and bridges, porcelains, and glass, as well as metal buckles, zippers, and utensils (Gawkrodger, 2005). Additionally it is found in foods such as B12 vitamin, apricots, chocolate, and liver (Garner, 2004). Chromate is another frequent cause of metal dermatitis, and is found in cement, plaster, drywall, yellow and green pigments (in paint and tattoos), and multivitamins (Rietschel & Fowler, 1995). Several foods high in chromium are brewer's yeast, liver, black pepper, molasses, eggs, banana, and spinach) (Weiler & Russel, 1986).


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