Pediatric Contact Dermatitis Guidelines

Updated: Jul 16, 2021
  • Author: Nanette B Silverberg, MD; Chief Editor: Dirk M Elston, MD  more...
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Guidelines Summary

Guidelines for the identification and management of nickel-allergic contact dermatitis (Ni-ACD) in children have been published in the subsection on dermatology by the American Academy of Pediatrics. [33] These guidelines are quoted below:

"The broad goals of medical therapy in Ni-ACD are as follows:

  1. identification and avoidance of nickel;
  2. treatment of skin inflammation; and
  3. restoration of the skin barrier and skin protection."

"The following are recommended to reduce the US pediatric burden of Ni-ACD:

  1. To minimize nickel-induced ACD in children, use of nickel in the manufacture of items that have direct or prolonged contact with the skin (eg, jewelry, electronic devices, toys, etc) should be limited. Regulations similar to the EU Nickel Directive that limit the weekly allowable release of nickel to less than 0.5 µg/cm2/week should be adopted.
  2. Additional safety and toxicity studies are needed to better understand the complex relationship between nickel exposure and population health.
  3. Companies and industries using metal in products should voluntarily create labeling for low–nickel-release products and Web-based resources to identify those items in the United States that follow EU legislation guidelines, allowing individuals who are nickel allergic to shop more wisely. Ideally, the development of trustable resources for those with Ni-ACD can be met through physician and industry partnership to develop educational resources about nickel allergy that can be easily understood and accessed by children, parents, and teachers.
  4. Physicians and other health care providers can support the reduction of Ni-ACD by encouraging parents to request that posts for piercings in their children’s ears be made of surgical-grade steel with low nickel release, per EU standards. It is recommended that all individuals who perform piercing services mention Ni-ACD as a potential complication of piercing.
  5. Nickel allergy can be genetic; therefore, physicians and other providers should consider educating at-risk groups to avoid nickel-based body piercings. There is further genetic reason to believe that children from families with a history of Ni-ACD would benefit from reduced exposure in childhood through the universal use of low–nickel-releasing jewelry.
  6. It is likely that most children would benefit from lower exposure to such contact, even in the absence of family history of Ni-ACD, because such family history is only present in approximately half of cases of documented disease.
  7. If orthodontic metal braces are anticipated, families should consider delaying ear piercing until after dental work is completed."