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
This 13-year-old girl had a solitary 2 x 2-cm erythematous, scaling patch on her right cheek for 3 months, despite the use of topical and intralesional steroids.
FIGURE 2 Rash beneath umbilicus
On exam: A 6 x 5-cm hyperpigmented, excoriated, lichenified, papulosquamous rash at the midline, beneath the umbilicus. The cause: The rivet on the patient’s blue jeans.
FIGURE 3 … around the wrist
On exam: An 8-mm diameter band of erythema and scaling around the wrist. The cause: The bracelet (shown), which would normally sit where the erythematous band is located.
FIGURE 4 … on the cheeks
On exam: A 0.8 x 3-cm arc of a papulosquamous rash on both cheeks. The cause: Eyeglasses.
FIGURE 5 … on the earlobes
On exam: A 0.5-cm patch of erythema, scaling, and crusting on the anterior and posterior sides of boThearlobes. The cause: Nickel in pierced earrings.
