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Policy helps identify, treat, prevent nickel allergy contact dermatitis :

April 27, 2020

Nickel allergy contact dermatitis (Ni-ACD) is problematic in pediatric dermatology, with sensitization noted in one-fourth of all patients. It is the most commonly identified cause of allergic contact dermatitis in children.

Recognizing Ni-ACD, treating the inflammation and eliminating the contact are important interventional strategies. In pediatrics, the power is in prevention.

A new AAP policy statement from the Section on Dermatology and Section on Allergy and Immunology reviews the epidemiology, history and appearance of Ni-ACD, with an aim to promote nickel-avoidance strategies on individual and global levels. The policy, Nickel-Allergic Contact Dermatitis: Identification, Treatment and Prevention, is available at and is published in the May issue of Pediatrics.

Appearance, burden

Ni-ACD presents with dermatitis (“eczema”), generally localized to the area of skin that came into contact with a high-releasing nickel object. The dermatitis is associated with redness, swelling and itching/discomfort.

These signs of Ni-ACD can be misinterpreted by parents and providers to be an infection, rather than inflammation that occurs with nickel allergy, especially if the reaction is associated with a skin trauma, such as earlobe piercing.

Once sensitization threshold is reached, each time there is contact with a nickel-releasing source, the allergic reaction can become more pronounced. Sometimes, the dermatitis can become widespread or involve sites distant from the area of contact with the source and be exuberant. This can involve significant symptoms, sleep disturbances and psychosocial stress on the child and family.

Key points

These actions can help address Ni-ACD:

  • Identify nickel contact source and avoid objects with high nickel release. Nickel is found in a multitude of metallic products, including earrings, belts, snaps, studs, zippers, electronics, razor blades, eyelash curlers, orthodontic braces and chairs.
  • Treat inflammation from Ni-ACD with emollients, topical steroids and/or calcineurin inhibitors.
  • Prevent Ni-ACDby avoiding objects with nickel release.There is no cure for Ni-ACD; the only sustainable treatment is prevention.


The following are among the policy’s recommendations:

  • The AAP supports adopting regulations similar to the European Union (EU) Nickel Directive to limit the weekly release of nickel to less than 0.5 µg/cm.
  • Companies and industries should label low nickel release products so individuals with nickel allergy can shop wisely.
  • Health care providers can encourage parents to request posts for piercings in their children to be made of surgical grade steel with low nickel release, per EU standards. If orthodontic metal braces are anticipated, however, families should consider delaying ear piercing.
  • As nickel allergy can be genetic, pediatricians can educate at-risk groups to avoid nickel-based body piercing.

Drs. Pelletier, Jacob and Silverbergare lead authors of the policy and are members of the AAP Section on Dermatology.

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