What should you know about nickel necklace rash?

Nickel can trigger allergic contact dermatitis, a delayed skin reaction after contact with an item. The outline may follow the chain, pendant, clasp, or any part resting against the neck. Itching, burning, dryness, small bumps, weeping, or crusting can occur. Sweat and friction may keep the metal against the skin and intensify irritation. A rash that spreads beyond the contact area, recurs with different jewellery, or continues after the necklace is removed deserves a clinical assessment because other causes include atopic dermatitis, psoriasis, fungal infection, or a medicine-related eruption.

Remove the necklace and avoid testing it again while the skin is inflamed. Rinse gently with lukewarm water, use a fragrance-free cleanser, pat dry, and apply a plain moisturiser. Keep nails short so scratching causes less damage. Do not apply perfume, exfoliants, or fragranced products to the area. A clinician or pharmacist can advise whether a suitable anti-inflammatory cream is appropriate and how long to use it. Later, choose jewellery labelled nickel-free only when the skin has recovered; coatings can wear away, so stop using an item if symptoms return.

Arrange medical advice if the rash is painful, hot, rapidly worsening, repeatedly returning, or not settling after avoiding the necklace. Seek prompt care for pus, increasing swelling, spreading redness, fever, or marked tenderness, which can signal infection. Get emergency help for swelling of the lips, tongue, or throat, trouble breathing, faintness, or widespread hives.

Could this be allergic contact dermatitis, and would patch testing identify nickel sensitivity? Which cleanser, moisturiser, or short course of treatment fits the affected skin? How should I protect my neck from future jewellery exposure?