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A 7-year-old girl was seen because of a 2-month history of an expanding patch of pruritus and scaling just below her umbilicus (figure 1). The patient also complained of a generalized rash on her arms and legs that had been present for 10 days. Physical examination revealed a 5-cm scaling, excoriated, and lichenified papulovesicular rash on her abdomen inferior to her umbilicus. A fine papular rash was seen on her arms and legs. The patient often wore "button fly" jeans in which the rivet behind the top metal button contacted her skin at the site of the abdominal rash. She had previously experienced a rash on both earlobes after wearing costume earrings.
A presumptive diagnosis of allergic contact dermatitis from exposure to nickel was made. A patch test using nickel sulfate in petroleum elicited a strong papulovesicular reaction and confirmed the diagnosis. A dimethylglyoxime test of the rivet of her blue jeans was positive for nickel. The rivet and metal buttons were replaced with plastic buttons, and triamcinolone acetonide 0.1% cream was applied twice daily. The condition promptly resolved and has not recurred.
Discussion
Nickel allergy is a commonly seen problem in the primary care setting. The incidence of nickel dermatitis, which appears to be increasing, is estimated to be 14% to 20% of women and 2% to 4% of men in the United States.1 (Reference) The primary means of sensitizing women to nickel is widely accepted to be the popular practice of ear piercing, usually with nickel-plated studs and clasps.2-4 (Reference) Sensitivity has even been shown to develop in infants who have their ears pierced within the first few weeks of life.5 (Reference)
Metal snaps, belt buckles, and nickel-containing buttons on blue jeans have been shown to be less common but significant causes of nickel dermatitis.2,5,6 (Reference) Perspiration, friction, pressure, and the amount of nickel that a particular alloy releases are directly proportional to the severity of the condition at clinical presentation; these variables also explain why the condition is almost uniformly worse in the summer.7 (Reference) Even supposedly...