What should you know about nickel allergy on neck?

A necklace clasp, chain, pendant, watch strap, zip, bra fastener or clothing stud can keep nickel against the neck. Friction and perspiration may increase contact and make the border of the rash resemble the item. Nickel contact dermatitis is often delayed, so symptoms may not appear immediately after wearing the item. Itching, scaling, burning and small fluid-filled blisters are possible. Eczema, fragrance, hair products and fungal or bacterial conditions can affect the same area, so the location is a clue rather than a diagnosis.

Remove the suspected metal from contact and wash the area with lukewarm water and a mild cleanser. Pat dry, use a plain moisturiser, and avoid scratching, perfume and hair products on broken skin. Photograph the rash and record which items touched it, including clothing and accessories. A dermatologist may recommend patch testing for nickel and related exposures. If inflammation needs treatment, a clinician may prescribe a topical corticosteroid for a limited course and explain where and how to apply it.

Book an assessment if the rash returns, spreads, affects the face, or continues after the suspected item is removed. Prompt care is needed for increasing pain, warmth, pus, fever, marked swelling or red streaking. Seek urgent help for breathing difficulty, throat swelling, faintness or widespread hives.

Which item is the most likely contact source? Could another product be contributing? Would patch testing clarify the diagnosis, and what can I use while the neck heals?