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Piercing and Metal Sensitivity: Extended Analysis of the North American Contact Dermatitis Group Data, 2007–2014

Warshaw, Erin M. MD, MS*†; Aschenbeck, Kelly A. BS*‡; DeKoven, Joel G. MD§; Maibach, Howard I. MD; Taylor, James S. MD; Sasseville, Denis MD#; Belsito, Donald V. MD**; Fowler, Joseph F. Jr MD††; Zug, Kathryn A. MD‡‡; Zirwas, Matthew J. MD§§; Fransway, Anthony F. MD∥∥; DeLeo, Vincent A. MD**; Marks, James G. Jr MD¶¶; Pratt, Melanie D. MD##; Mathias, Toby MD***

doi: 10.1097/DER.0000000000000324

Background Body piercing provides a unique route of metal exposure.

Objective The aim of this study was to update previous analyses using the North American Contact Dermatitis Group data comparing pierced and unpierced individuals.

Methods This was a retrospective cross-sectional analysis of 17,912 patients patch tested by the North American Contact Dermatitis Group from 2007 to 2014 for demographics, positive reactions to metals (nickel, cobalt, chromium), and detailed analysis of nickel reactions by age, sex, and source of exposure.

Results Piercing was significantly associated with female sex, being older than 18 years, and atopy (P < 0.003). Nickel sensitivity was associated with 1 or more piercing for men and women combined (P < 0.0001; relative risk [RR], 2.54; 95% confidence interval [CI], 2.35–2.75), although this association was stronger for men (RR, 2.21; 95% CI, 1.77–2.76) than women (RR, 1.47; 95% CI, 1.31–1.65). The frequency of positivity to nickel increased with number of piercings (14.3% for 1 piercing to 34.0% with ≥5 piercings). Piercing was not significantly associated with cobalt sensitivity alone (P = 0.8992) and was negatively associated with chromium sensitivity (P < 0.0001). Jewelry was the most common source of allergic reactions to nickel irrespective of sex or pierced status.

Conclusions Nickel sensitivity was significantly associated with piercing in both men and women. Jewelry was the most common source.

From the *Department of Dermatology, Minneapolis Veterans Affairs Medical Center, MN; †Department of Dermatology, University of Minnesota Medical School; and ‡University of Minnesota School of Medicine, Minneapolis; §Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; ∥Department of Dermatology, University of California, San Francisco, CA; ¶Department of Dermatology, Cleveland Clinic, OH; #Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada; **Department of Dermatology, Keck School of Medicine, Los Angeles, CA; ††University of Louisville, KY; ‡‡Dartmouth-Hitchcock Medical Center, Lebanon, NH; §§Ohio State University, Columbus; ∥∥Associates in Dermatology, Fort Myers, FL; ¶¶Department of Dermatology, Pennsylvania State University, State College; ##Division of Dermatology, University of Ottawa, Ontario, Canada; and ***Department of Dermatology, University of Cincinnati, OH.

Corresponding author: Erin Warshaw, MD, MS. E-mail:

This study was supported by the Nickel Producers Environmental Research Association.

The authors have no conflicts of interest to declare.

This material is the result of work supported with resources and the use of facilities at the Minneapolis Veterans Affairs Medical Center. The contents do not represent the views of the US Department of Veterans Affairs or the US Government.

© 2017 American Contact Dermatitis Society
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