Photo Rounds

Rash around belly button

An 18-year-old woman presented to her family physician with a pruritic rash around her belly button that had begun a month prior. She had just bought a new belly button ring 2 months earlier and was hoping she wouldn’t have to remove it. The patient was otherwise in good health.

What’s your diagnosis?


The family physician (FP) recognized that the patient’s new belly ring was the cause of this case of contact dermatitis. The FP suspected that the belly ring contained nickel—a common culprit in cases of allergic contact dermatitis (ACD).

ACD is a delayed-type hypersensitivity reaction that occurs when skin proteins form an antigen complex in reaction to a foreign substance. Upon reexposure of the epidermis to the antigen, the sensitized T cells initiate an inflammatory cascade, leading to the skin changes seen in ACD.

The FP told the patient that patch testing could be used to confirm her allergy, but it required wearing patches on her back for 3 days and involved 3 office visits to complete the testing. He also asked her if she wanted to have her jewelry tested for nickel content.

The patient removed the belly button jewelry and the FP used a nickel testing kit, which showed the jewelry was, in fact, positive for nickel. The patient asked if she could still wear the jewelry if she got medication to treat the allergy, but the FP explained that it was unlikely that the rash would go away completely with a topical cream if the jewelry remained in place. The FP prescribed 0.1% triamcinolone cream to be applied twice daily to the area. He also suggested that she look for a jewelry replacement that was nickel-free.

At a one-month follow-up visit, the patient acknowledged that the FP had been right: While she was able to wear the jewelry for another 2 weeks with decreased erythema and pruritus while using the triamcinolone cream, the rash never went away. The patient switched to a nickel-free belly button ring and her rash cleared completely.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Contact dermatitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:591-596.

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