Contact Dermatitis from Imitation Jewelry: Clinical Insights from A Case Report

Abstract

Irritant contact dermatitis (ICD) is a frequent inflammatory skin condition caused by exposure to allergens. Imitation jewelry, often made from inexpensive metals such as nickel, cobalt, or chromium, is a known source of sensitizing agents. We report the case of a 50-year-old female who developed symptoms over the neck region following the use of imitation necklace. Patch testing confirmed sensitivity to nickel. The dermatitis resolved with the avoidance of allergen exposure and appropriate therapy with corticosteroids and antihistamines. This case highlights the importance of recognizing everyday items such as costume jewelry as potential allergens, and emphasizes the role of patient education in the prevention of recurrent episodes.

Keywords

Introduction

Contact dermatitis (CD) is an inflammatory dermatosis induced by chemicals or metal ions that produce irritating effects or by microscopic reactive agents (contact allergens) that alter proteins and provoke immunological responses.⁽¹⁾ ICD is caused by environmental factors or external substances damaging the skin barrier.⁽²⁾ Genetic predisposition and a small number of significant exposure types—such as wet labor, glove use, detergents, food, and solvents/oils—are linked to the risk of ICD⁽³⁾. Allergy to metals can lead to allergic contact dermatitis. The ability of electrophilic metals to ionize and react with proteins to create complexes that are detectable by dendritic cells makes sensitization possible. The literature has documented cases of contact dermatitis brought on by skin contact with nickel-containing jewelry and cosmetics. ⁽⁴⁾ Here, we report on a female patient who developed irritating contact dermatitis because of the use of artificial jewelry (nickel) around her neck.

Case Report

A 50-year-old female patient presented to the department of Dermatology with the complaints of itching over left side of neck - intense in severity, present throughout the day, affecting sleep and daily routine which was followed by redness and scaling over the area and as patient scratched there was exudation of clear fluid. These changes were also associated with burning sensation. The patient presented with a positive history of using artificial jewelry (constituting Nickel) prior to the onset of complaints. She presents with a history of similar complaints in past on using artificial jewelry (bangles) 1 year ago over bilateral arms, which was resolved in a period of 2 weeks on medication. The patient had no history of any dust, pollen, drug, seafood, egg, or other allergies. The patient also denied any insect bites or topical applications prior to onset of lesions. Upon arrival, the patient was cooperative, alert, and aware of time, location, and individuals. She is a known of hypertension for 20 years and is on regular medication. Results of cutaneous examination is as follows:

Table 1 – Results of Cutaneous Examination

Figure 1 - Ill-defined erythematous plaques over left side of neck

Treatment

The patient was given Hydrocortisone intravenously to reduce inflammation and irritation. Further She was also treated with antihistamines such as Fexofenadine and Levocetirizine to reduce symptoms such as itching. Calamine lotion was applied topically to reduce skin irritation and discomfort. The affected region was also treated with saline compression followed by application of Mometasone Furoate and Fusidic Acid Cream to address both inflammation and potential bacterial infection. The complaints of erythema and itching was reduced during treatment and the patient was comfortable. Patch testing was performed with Indian standard series containing nickel, chromium, and cobalt 2 weeks later. Patch test revealed 2+ reaction to nickel at 48 and 72 hours.

DISCUSSION

Two well-known causes of contact dermatitis are nickel and mercury. Ear piercing was linked to nickel sensitivity; the most common allergy found during patch testing.⁽⁵⁾  Twelve children with peri-umbilical nickel dermatitis brought on by dimethylglyoxime-positive belt buckles have been found to have allergic contact dermatitis by Alina Goldberg et al. Avoiding products containing nickel was found to alleviate the patients' symptoms. ⁽⁶⁾ Steel and other alloys comprising cobalt, palladium, iron, titanium, gold, and magnesium are produced from this metal. After being exposed to nickel through the skin, sensitive people typically have a predictable localized reaction that includes itching, vesicle development, erythema, and scaling. Recent research indicates that women are almost four times as likely than men to develop allergic contact dermatitis to nickel. ⁽⁴⁾ The availability of inexpensive fashion jewelry that emits nickel when it comes into touch with perspiration and the fact that women wear it frequently are two major factors contributing to the high incidence rate among females. When nickel ions from these materials come into touch with human skin, they can cause sensitization, particularly if the contact lasts for a long time. Numerous common jewelry pieces, personal belongings, and clothing accessories contain free nickel. ⁽⁷⁾ Based on clinical presentation, history, and patch test findings in our case, we postulate that associated changes observed were simply an expression of contact dermatitis to nickel released from imitated jewelry. These kinds of consumer items are widely available in our market. People are unknowingly constantly exposed to one of the most prevalent sensitizers in the world. It is high time that the public is informed about this menace and our government limits the use of nickel in jewelry/clothing accessories.

REFERENCES

1. Li Y, Li L. Contact Dermatitis: Classifications and Management. Vol. 61, Clinical Reviews in Allergy and Immunology. Springer; 2021. p. 245–81.
2. Patel K, Nixon R. Irritant Contact Dermatitis — a Review. Vol. 11, Current Dermatology Reports. Springer; 2022. p. 41–51.
3. Johansen JD, Bonefeld CM, Schwensen JFB, Thyssen JP, Uter W. Novel insights into contact dermatitis. Journal of Allergy and Clinical Immunology. 2022 Apr 1;149(4):1162–71.
4. Yoshihisa Y, Shimizu T. Metal allergy and systemic contact dermatitis: An overview. Vol. 2012, Dermatology Research and Practice. 2012.
5. Nallamilli M. Study Of Contact Dermatitis To Cosmetics, Wearing Apparel And Jewellery By Patch Testing Doctor Of Medicine In Dermatology, Venereology And Leprology Under the guidance of.
6. Goldenberg, A., Admani, S., Pelletier, J. L., & Jacob, S. E. (2015). Belt Buckles-Increasing Awareness of Nickel Exposure in Children: A Case Report. Pediatrics, 136(3), e691–e693. https://doi.org/10.1542/peds.2015-0794
7. Letters to the Editor Nickel nuisance: A clinical observation.