Metal Allergy pp 423-434 | Cite as

Metal Allergy: Nickel

  • Carola Lidén


Nickel is the most common skin sensitizer, affecting large proportions of the population. Nickel allergy is more prevalent among girls and women than boys and men, owing to differences in exposure patterns. There are large differences in prevalence between age groups, countries and occupations, over time. Skin exposure to nickel in various consumer articles results in nickel allergy and dermatitis on exposed body parts, including the hands. Occupational exposure to nickel is an important cause of occupational skin disease, particularly hand eczema. Nickel allergy has started to decline in some countries owing to the EU restriction of nickel.

Nickel is used in numerous products and materials, and it is difficult to avoid nickel. It is necessary to identify sources of exposure in the workplace, home and leisure environment for exposure reduction and prevention of dermatitis. The dimethylglyoxime (DMG) test is a useful tool. Nickel release can also be quantified by immersion in artificial sweat, and it is now possible to quantify nickel on the skin.

Patients with hand eczema and nickel allergy often have recurrent vesicular hand eczema. Occupational nickel exposure should be considered in nickel-allergic patients with hand eczema. Nickel sulphate 5% is used in the European baseline series. It is safe to use, patch test sensitization has not been reported, and the proportion of irritant and doubtful reactions is low. Patients with nickel allergy and contact dermatitis should be encouraged to use the DMG test to minimize nickel exposure from personal items, in the workplace and during leisure.


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Environmental MedicineKarolinska InstitutetStockholmSweden

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