Relevance of positive nickel patch test

Nickel has for years been the most common contact allergen world-wide with exception of poison ivy in U.S. Nickel allergy is frequently associated with a present or past history of costume jewellery dermatitis and ear-piercing. The strength of association differs within geographical regions and depends upon regional legislation. In a country like Denmark, where a regulation restricting nickel release from metallic items designed to be in direct and prolonged contact with the skin has been in force since 1991 a positive patch test to nickel is presently mainly of past relevance (1). A positive dimethylglyoxime test from suspected metallic items supports the relevance decision (2).

Generally it is difficult to establish the relevance of a positive nickel patach test i relation to hand eczema. This subject has recently been thoroughly discussed by Lidén et al. (3). From a practical point of view the dimethylglyoxime test can be useful in the evaluation of occupational exposure from metallic items and tools. In case of exposure to e.g. cutting oils, atomic absorption analysis is necessary. Measurements of nickel in nails and skin can be used as biomarkers of exposure (3) but such test needs further clinical evaluation and standardization.

References:
1.
CS Jensen, S Lisby, O Baadsgaard, A Volund, T.Menné.
Nickel allergy in Danish schoolgirls and adolescent girls: effect of nickel-exposure regulation, age, ear-piercing and oral braces.
BJD 2001: in press.

2.
B Gruvberger, M Bruze, S Fregert.
Spot tests and chemical analyses for allergen evaluation.
p. 494-510. In: Textbook of Contact Dermatitis.
Eds. RJG Rycroft, T Menné, PJ Frosch, J-P Lepoittevin.
Third Edition. Springer-Verlag Berlin Heidelberg 2001.

3.
C Lidén, M Bruze, T Menné.
Metals.
p. 933-979. In: Textbook of Contact Dermatitis.
Eds. RJG Rycroft, T Menné, PJ Frosch, J-P Lepoittevin.
Third Edition. Springer-Verlag Berlin Heidelberg 2001.