Nickel eczema: what to know

The rash may appear beneath jewellery, a watch, belt buckle, clothing fastener, phone contact point or another metal surface. Redness, itching, scaling, tiny blisters or cracking can develop after contact, and the reaction may spread slightly beyond the exact contact area. Sensitisation can persist, so a flare may recur whenever the same source touches the skin. Atopic dermatitis can also make the barrier more reactive, but a contact allergy is assessed separately.

Stop wearing the suspected item while the rash settles and note every metal that touches the area. Choose products labelled nickel-free where possible, keep a barrier between skin and unavoidable fasteners, and avoid applying fragrance to irritated skin. Moisturise regularly to support the damaged barrier. If the trigger is unclear or flares continue, a dermatologist may discuss patch testing to identify contact allergies and prescribe treatment for inflammation.

Arrange an assessment when the rash persists after avoiding the suspected metal, returns repeatedly, affects a large area or disrupts sleep. Seek prompt help for increasing pain, warmth, swelling, pus, spreading crusts or rapidly worsening symptoms, which can signal infection in broken skin. Swelling of the face or difficulty breathing requires emergency care.

Could this be nickel contact allergy, atopic dermatitis or another cause? Would patch testing help identify the source? Which jewellery, fasteners or workplace materials should I avoid, and what should I use on the inflamed skin?