Why I Give: Sarah Young O’Donnell
Sarah Young O’Donnell, from New York City, shares how she and her family discovered NEA and what it means to her to give back.
Published On: May 14, 2024
Last Updated On: Sep 12, 2024
We are surrounded by metals in our everyday lives. There are hundreds of products and commonplace items with metal in them: everything from belts and jewelry to our phones and keys. Metals including nickel, chromium, cobalt chloride, copper and gold are common triggers for eczema, particularly contact dermatitis.
Contact dermatitis happens when the skin becomes irritated or inflamed after coming into contact with a substance that triggers an allergic reaction. The American Academy of Allergy Asthma & Immunology estimates up to 20% of people experience contact dermatitis.1
It’s especially important for patients with atopic dermatitis (AD) to know whether they are sensitive to a specific metal. “If an allergic contact dermatitis to metal occurs on a person with AD, it can worsen skin inflammation and itch symptoms,” said Dr. Vivian Shi, professor of dermatology and director of clinical trials at the University of Washington in Seattle.
Here’s a look at where these metals are found in everyday items.
Nickel is the most prevalent culprit, according to the American Academy of Dermatology (AAD), which estimates nearly 1 in 5 people in North America are allergic to it.2 Nickel is found in accessories like necklaces, bracelets and belts; in clothing fasteners like zippers, buttons and bra hooks; and in electronics like mobile phones and laptops. It is also used in appliances like toasters, grills and irons; in kitchenware like pots, pans and silverware; and in kitchen sinks.3
“Nickel can also be found in dental devices like braces and dentures, which can cause oral lesions,” said Dr. Shi. It can end up in food including green vegetables, legumes, chocolate and whole wheat products, as well as in drinks like red wine, beer and tea.4
“Chromium is typically found in paints, welding materials and pottery,” said Dr. Shi. It is also present in many foods including grains, meats, fruits, vegetables and spices, although the amount can vary widely based on the manufacturing process or the amount of chromium in the soil or local water supply.5 Multivitamin and mineral supplements may also contain chromium.5
Items such as spray paints, wood stains, light brown hair dyes and makeup may contain cobalt chloride.6 “Cobalt metal is the pigment used in blue tattoo ink, resulting in allergic contact dermatitis cases from new tattoos,” said Dr. Shi.
Cobalt chloride is also used in bricks and cement and can be found in metal tools, orthopedic and dental implants, and items like magnets, keys and costume jewelry.6
According to the U.S. Mint, pennies are coated with copper.7 This metal is present in sterling silver and gold jewelry.8 Electrical wires commonly contain copper, as well as the plumbing in your home.8 Copper may also be present in dental appliances like crowns, dentures and veneers, and in intrauterine contraceptive devices (IUDs).8
In addition to its popularity in jewelry, gold has many other uses. Cosmetic products designed to reduce the appearance of wrinkles and brighten skin may contain gold nanomaterials.9 Gold may be present in dental fillings and medical devices like coronary stents.10 Gold salts are also used as a treatment for arthritis.11
The exact trigger for contact dermatitis is not always obvious because the reaction isn’t typically immediate. “In allergic contact dermatitis, the reaction can often take two to three days after the exposure,” said Dr. Benjamin Ungar, dermatologist and Director of the Alopecia Center of Excellence and Director of the Rosacea & Seborrheic Dermatitis Clinic at Mount Sinai in New York.
Symptoms include itchy, red skin and rashes, swelling or bumps and blisters. The skin may become dry and scaly or feel like it’s burning.
Dr. Shi said her patients often ask about metals triggering full-body reactions. “This is called systemic contact dermatitis and is usually a result of eating foods that contain traces of metal allergens, most commonly nickel,” she explained.
“Rash from systemic contact dermatitis can appear in places previously exposed to the allergen or as a widespread rash,” she said. “It should resolve with the removal of the allergen.”
Researchers point to dermal absorption as a reason why metals can be troublesome for so many people. As described by the Centers for Disease Control and Prevention, “dermal absorption happens when a chemical goes through the skin and travels into the body.”12
Metals like nickel may be corroded during direct and prolonged contact with skin, especially sweaty skin.13 When that happens, the metal’s particles may enter the skin, react with proteins7 and initiate an allergic response.14 While nickel is the most common trigger, chromium, copper, cobalt and gold can also elicit the same effect.15,16,17
“In people with allergic contact dermatitis, there are immune cells that recognize a specific chemical, such as a metal, and react to exposure of that chemical onto the skin,” Dr. Ungar said.
“Not all people with atopic dermatitis will necessarily experience aggravation with exposure to metals,” he added. “This is still an area of study, but overall, it is likely that people with AD, and potentially seborrheic dermatitis, may be at greater risk of experiencing contact dermatitis given that their skin barrier can be disrupted by their disease, which may contribute to the development of contact dermatitis.”
“It’s not advantageous to avoid all common metals without known allergic reactions,” said Dr. Shi. That’s why she and Dr. Ungar both recommend patch testing to verify which metals prompt an eczema flare in a patient. Patch testing involves placing an allergen on the patient’s skin and observing whether it triggers an allergic reaction within two to seven days.
“Once you know a certain metal triggers symptoms, the best prevention is to avoid the metal as much as possible,” Dr. Ungar said.
The AAD recommends replacing metal pieces on your clothing, like buttons and zippers, with plastic-coated alternatives. Instead of costume jewelry, wear hypoallergenic pieces made from materials like sterling silver and titanium.18 Dr. Shi also said she advises her patients to “always read product labels and if it’s not available, you can reach out to the manufacturer for more information.”
Download EczemaWise, an app created by the National Eczema Association. You can keep track of triggers, flares and more to reveal trends in your eczema that can help you and your doctor find solutions. Learn more at EczemaWise.org
References:
1Contact Dermatitis Overview. Aaaai.org. Updated December 11, 2023. Accessed April 30, 2024. https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/contact-dermatitis-overview
2 Nickel Allergy: How to Avoid Exposure and Reduce Symptoms. Aad.org. Accessed April 30, 2024. https://www.aad.org/public/diseases/eczema/insider/nickel-allergy
3Consumer products: the role of nickel. Nickelinstitute.org. Accessed May 8, 2024. https://nickelinstitute.org/en/about-nickel-and-its-applications/consumer-products/
4Sharma AD. Low Nickel Diet in Dermatology. Indian J Dermatol. 2013; 58(3): 240. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667300/
5Chromium. Ods.od.nih.gov. Updated June 2, 2022. Accessed May 8, 2024. https://ods.od.nih.gov/factsheets/Chromium-HealthProfessional/
6Cobalt dichloride. Smartpractice.com. Accessed May 8, 2024. https://www.smartpractice.com/dermatologyallergy/pdfs/allergens/Cobalt-Dichloride.pdf
7Fun Facts related to the Penny. Usmint.gov. Accessed May 8, 2024. https://www.usmint.gov/learn/kids/coins/fun-facts/category/penny
8 Fage SW, Faurschou A, Thyssen JP. Copper hypersensitivity. Contact Dermatitis. 2014. https://onlinelibrary.wiley.com/doi/10.1111/cod.12273
9Liu C, Wang Y, Zhang G, Pang X, Yan J, Wu X, Qiu Y, Wang P, Huang H, Wang X, Zhang H. Dermal Toxicity Influence of Gold Nanomaterials after Embedment in Cosmetics. Toxics. 2022 Jun; 10(6): 276. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9228324/
10Hopkins K, Antelmi A, Dahlin J, Olsson K, Svedman C, Astrand J, Bruze M. Increased Rates of Gold and Acrylate Allergy in Individuals with Fibromyalgia tested with an Extended Dental Patch Test Series. Acta Derm Venereol. 2023; 103: 22336. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10726376/
11Gold Treatment. Orthop.washington.edu. Accessed May 8, 2024. https://orthop.washington.edu/patient-care/articles/arthritis/gold-treatment.html
12Skin Exposures and Effects. Cdc.gov. Updated January 18, 2022. Accessed April 30, 2024. https://www.cdc.gov/niosh/topics/skin/default.html
13Genchi G, Carocci A. Lauria G, Sinicropi MS, Catalano A. Nickel: Human Health and Environmental Toxicology. Int J Environ Res Public Health. 2020; 17(3): 679. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037090/
14Yoshihisa Y, Shimizu T. Metal Allergy and Systemic Contact Dermatitis: An Overview. Dermatol Res Pract. 2012; 749561. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3369403/
15What Are the Physiologic Effects of Chromium Exposure? Atsdr.cdc.gov. Updated May 24, 2023. Accessed May 1, 2024. https://www.atsdr.cdc.gov/csem/chromium/physiologic_effects_of_chromium_exposure.html
16Hostynek JJ, Dreher F, Maibach H. Human skin penetration of a copper tripeptide in vitro as a function of skin layer. Inflamm Res. 2011; 60(1): 79–86. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016279/
17Report on Carcinogens Monograph on Cobalt and Cobalt Compounds That Release Cobalt Ions In Vivo: RoC Monograph 06 [Internet]. ncbi.nlm.nih.gov/. Updated April 2016. Accessed May 1, 2024. https://www.ncbi.nlm.nih.gov/books/NBK580284/
18Markel K, Silverberg N, Pelletier JL, Watsky KL, Jacob SE. Art of Prevention: A piercing article about nickel. Int J Womens Dermatol. 2020. 6(3): 203–205. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330428/
Sarah Young O’Donnell, from New York City, shares how she and her family discovered NEA and what it means to her to give back.
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