Clinical Pharmacist and Master’s student in Clinical Pharmacy with research interests in pharmacovigilance, behavioral interventions in mental health, and AI applications in clinical decision support. Experience includes digital health research with Bloomsbury Health (London) and pharmacovigilance practice in patient support programs. Published work covers drug awareness among healthcare providers, postpartum depression management, and patient safety reporting. 
Clinical Pharmacist and Master’s student in Clinical Pharmacy with research interests in pharmacovigilance, behavioral interventions in mental health, and AI applications in clinical decision support. Experience includes digital health research with Bloomsbury Health (London) and pharmacovigilance practice in patient support programs. Published work covers drug awareness among healthcare providers, postpartum depression management, and patient safety reporting. What was reviewed?
This article provides a comprehensive review of nickel contact dermatitis (Ni ACD) in children, focusing on its clinical manifestations, sources of exposure, diagnostic challenges, and management strategies. The review synthesizes data from epidemiological studies, clinical reports, legislative outcomes, and therapeutic trials to illuminate the complexity of nickel allergy in pediatric populations. Emphasis is placed on the rising prevalence of Ni ACD, the diversity of exposure sources, including both traditional (jewelry, buttons) and modern (technology devices) items, and the importance of recognition and prevention. The review also examines the immunological mechanisms underlying nickel hypersensitivity, highlights the role of regulatory interventions, and discusses implications for avoiding and managing allergic reactions in children.
Who was reviewed?
The article synthesizes findings from a variety of studies involving children and adolescents with nickel contact dermatitis, as well as broader cohorts that include adults for comparative purposes. It references epidemiological data from cohorts in the United States and Europe, including longitudinal studies of adolescents, patch testing series in children, and populations with comorbid atopic dermatitis. The review also incorporates legislative impacts observed in European populations post-implementation of nickel release regulations, and summarizes case reports and clinical experiences relevant to pediatric dermatology. Thus, while the primary focus is on pediatric patients, some findings are contextualized with data from adults and special subpopulations (e.g., those with atopic dermatitis or occupational exposures).
Most important findings
| Aspect | Details / Findings |
|---|---|
| Prevalence & Risk | Skin piercing increases sensitization, but non-pierced children affected. Sweat, friction, and environmental/lifestyle factors enhance nickel release. |
| Clinical Presentation | Ranges from localized dermatitis to systemic nickel allergy syndrome; often complicated by comorbidities like atopic dermatitis. |
| Risk Factors | Skin piercing increases sensitization, but non-pierced children are affected. Sweat, friction, and environmental/lifestyle factors enhance nickel release. |
| Legislation | EU Nickel Directive reduces sensitization by controlling nickel release in consumer products. |
| Diagnosis | Primarily clinical history and patch testing; histopathology is nonspecific. Pathogenesis involves innate/adaptive immunity, T-cell responses, and genetic predisposition; sensitization is usually permanent. |
| Management – Avoidance | Avoidance is key, but complete elimination is impractical. Strategies include: dimethylglyoxime spot testing of products, high-purity metals for jewelry (24k gold, 980 silver), and modifying clothing/household practices. |
| Management – Diet | Dietary nickel restriction for systemic manifestations; complete avoidance is not recommended due to the nutritional role of nickel. |
| Pharmacologic Interventions | Topical corticosteroids, calcineurin inhibitors (tacrolimus, pimecrolimus); phototherapy for refractory cases. |
| Investigational Therapies | Oral hyposensitization, NADH, phosphodiesterase inhibitors, tea tree oil; limited pediatric safety/efficacy data. |
Key implications
For the Heavy Metal Tested and Certified (HTMC) program, this review emphasizes the need for strict regulation and rigorous testing of nickel, particularly in products for children. Reliance on consumer vigilance is insufficient; legislative measures, such as limits on nickel release, effectively reduce sensitization and disease burden. Given the persistence of nickel allergy, primary prevention through exposure control is essential. Certification programs should focus on testing jewelry, clothing fasteners, and electronic devices, with clear guidelines on permissible nickel release. Additionally, educational initiatives for consumers and manufacturers, along with labeling and alternative product recommendations for sensitized individuals, are critical to minimize disease impact and enhance quality of life.
Citation
Tuchman M, Silverberg JI, Jacob SE, Silverberg N. Nickel contact dermatitis in children. Clinics in Dermatology. 2015;33(3):320–326. doi:10.1016/j.clindermatol.2014.12.008
Heavy metals are high-density elements that accumulate in the body and environment, disrupting biological processes. Lead, cadmium, arsenic, mercury, nickel, tin, aluminum, and chromium are of greatest concern due to persistence, bioaccumulation, and health risks, making them central to the HMTC program’s safety standards.
