Topical and Systemic Therapies for Nickel Allergy

Abstract and Introduction

Abstract

Nickel allergy can result in both cutaneous and systemic manifestations, and can range from mild to severe symptoms. A severe form of this allergy is the Systemic nickel allergy syndrome, clinically characterized by cutaneous manifestions (contact dermatitis, pompholyx, hand dermatitis dyshydrosis, urticaria) with chronic course and systemic symptoms (headache, asthenia, itching, and gastrointestinal disorders related to histopathological alterations of gastrointestinal mucosa, borderline with celiac disease). This review aims to briefly update the reader on past and current therapies for nickel contact allergy.

Introduction

ALLERGIC CONTACT DERMATITIS (ACD) from nickel is an inflammatory skin condition, caused by a type IV hypersensitivity response, that manifests itself after recurrent contact with the metal. The prevalence of ACD from nickel is increasing worldwide because of the widespread presence of this metal in our environment. The clinical manifestations are related to the phase of dermatitis: the acute phase can be characterized by itching, erythema, edema, vesicles, and scaling with visible borders, and the chronic phase by lichenification and itching. Risk factors are the sensitizing potential of the allergen, high frequency of exposure, occlusion, prolonged time of contact, presence of penetration-enhancing factors, and altered skin barrier function. In fact, described recently are null mutations in the filaggrin gene complex and an alteration of toll-like receptor 4 (TLR4) in allergic patients have recently described.^[1,2]

Nickel is the main sensitizer; its prevalence varies from 4.0 to 13.1% in different countries and is still increasing. Nickel allergy is more common among women than among men (17% and 3%, respectively). This difference is due to different rates of exposure of skin to this substance; such exposure (from jewelry, leathers, etc) is more frequent among women. Nickel allergy has also been noted as prevalent among certain workers, such as hairdressers, domestic cleaners, metalworkers, and caterers, owing to their repeated exposure to this metal. Furthermore, nickel is present in a large number of foods (mainly vegetables), another source of exposure for sensitized patients.^[3]

Nickel allergy can result in both cutaneous and systemic manifestations, and its signs and symptoms can range from mild to severe. A more severe form is systemic nickel allergy syndrome (SNAS), which is clinically characterized by cutaneous manifestations (such as contact dermatitis, pompholyx, hand dermatitis, dyshydrosis, and urticaria), a long-term course, and systemic symptoms (such as headache, asthenia, itching, and gastrointestinal disorders related to histopathologic alterations of gastrointestinal mucosa, borderline with celiac disease).^[4]

This review aims to briefly update the reader on past and current therapies for nickel contact allergy.

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