Pruritic rash
Each of these 5 patients had a pruritic rash. The locations varied: face, ears, wrist, and waist. But the cause was the same.
Diagnosis: Nickel dermatitis
Each of these 5 patients had allergic contact dermatitis caused by nickel. The cheek dermatitis was produced by contact with the circular “menu” button on the patient’s cell phone (Case 1/ FIGURE 1 ), the periumbilical rash by the rivet behind a blue jeans button (Case 2/ FIGURE 2 ), the wrist dermatitis by a bracelet (Case 3/ FIGURE 3 ), the rash on the upper cheeks by eyeglass frames (Case 4/ FIGURE 4 ), and the earlobe dermatitis by earrings (Case 5/ FIGURE 5 ). The presence of nickel in each object was confirmed with a positive dimethylglyoxime (DMG) test.
What you’ll see. Besides an erythematous, pruritic, scaling rash, other findings can include vesicles and bullae that break and form crusts at sites of contact. Extreme pruritus is also commonly seen and prompts chronic rubbing and scratching, resulting in the development of lichenification and hyper-pigmentation.
FIGURE 1
Scaling patch on cheek
FIGURE 2
Rash beneath umbilicus
The cause: The rivet on the patient’s blue jeans.
FIGURE 3
… around the wrist
The cause: The bracelet (shown), which would normally sit where the erythematous band is located.
FIGURE 4
… on the cheeks
The cause: Eyeglasses.
FIGURE 5
… on the earlobes
The cause: Nickel in pierced earrings.
