When it comes to the recognition of Nickel as the number one metal allergen worldwide, affecting up to 30% of adults and with a particular predilection for women, it seems like Australian health professionals really do come from the ‘land down under’, with many of us still somehow yet to read that memo.
Documentation of this phenomenon and the building evidence regarding exactly how Nickel sensitisation drives disease, its many manifestations and new evidence-based approaches for improved management, have been making big waves overseas. I’ve been following the research with great interest because this is one of those health issues that once you ‘see it’ – you realise all the patients in the rear-view mirror that you previously missed.
And it is now especially front of mind & no longer somewhere deep down in the differentials when I am presented with a patient, ‘in a skin and gut pickle’ – I think, Nickel!
Just such a case was presented to me recently. A 37yo woman with no hx of atopy or any skin conditions who at the age of 32 developed an extensive rash. She had the golden giveaway: ‘I did sometimes get a rash on my hands from wearing a ring’, that, as a minimum, confirms Ni associated Acute Contact Dermatitis (ACM) but could the severe ‘eczema’ that then spread to most of her body and scalp, causing patches of alopecia to boot, be the progression of this same original assault? And what about all her gut issues and growing list of foods she can’t tolerate etc etc etc.? She’s taken so many things out, her symptoms aren’t lessening but her levels of basic nutrients are!
Cases like these get complicated and conflated quickly because both patient and practitioner feel the weight & the worry of the escalating severity and it is easy to become reactive in our approach – take this out, stop that, try this – rather than reflective.
The practitioner this patient came to see, an integrative skin specialist with lots of experience in eczema, knew they weren’t winning and took the time and care to comprehensively work up this case under my supervision. She indeed had read the Nickel memo and she flagged it from the outset…’oh dear I fear this might be a Nickel Allergy’ but being loathe to point her finger at yet another potential suspect and restrict the diet in any way, she didn’t know how to proceed. This is where even those of us who are Ni-aware are falling down & potentially failing our patients. Nickel allergy is not a functional fad – it is a driver of organic disease and there’s growing research-road-tested input into effective management – check out the latest research and keep up to date 🤓
Eczema – In a Pickle with Nickel?
Nickel, the most common metal allergen worldwide, is presenting in our clinics cloaked in many disguises: the refractory ‘irritated’ gut, recurring cracked corners of the mouth and cheilitis, idiopathic urogenital symptoms and a wide variety of skin complaints, including ‘eczema’. This is a case summary of a 37yo female presenting with ‘all of the above’ and more. We unpack the clues, the chronology of the disease progression – examine her original and perpetuating risks and discuss the very latest research that, at last, documents the damage caused by Ni-Allergic Contact Mucositis (ACM) to GIT structure and function, as well as new evidence for improved management. For those new to Nickel allergy this is a total eye-opener and for those of us with Nickel already firmly on our radar, this pulls no punches in what we’ve been getting wrong in our approach to management.
You can purchase Eczema – In a Pickle with Nickel? here.
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