Wedding Ring Dermatitis - Article by Wall Street Journal

Till Dermatitis Do Us Part
By MELINDA BECK

The fairy tale goes like this: a couple meets, falls in love, exchanges rings and lives happily ever after.
Nowhere does it mention that an itchy red rash might develop under the ring, turning that symbol of love into a source of irritation.

Yet thousands of women (to judge by postings on the Internet) and a growing number of men develop what's officially called "wedding-ring dermatitis"—not to be confused with the "seven-year itch"—and it can happen suddenly after years of ring-wearing bliss.

"I'd wake up in the middle of the night and scratch at my hands with a hair brush until they bled it was so itchy," says Ann Connelly, chief operating officer of a tutoring company in Potomac, Md. She stops wearing her gold wedding ring until the rash heals, then wears it until it starts again. "But I try to remember to wear it if I'm going out with my husband. The other day we had lunch and a waiter greeted him as Mr. Connelly and waited to make sure I was the Mrs."

Dermatologists say there are two common causes of wedding-ring dermatitis. One is an allergic reaction to the metal, generally nickel, which can be present in small quantities even in expensive gold and platinum rings. The other is a surface irritation from moisture and soap trapped under the ring, which can occur with any kind. Both cause similar red, scaly welts, and it can be tricky to tell them apart. Yet it's also important to know the cause before you spend thousands of dollars on a replacement ring.

Nickel allergies have been on the rise in North America in recent years and now affect 24% to 36% of women and 7% to 15% of men, according to the North American Contact Dermatitis Group, which named nickel the 2008 "Allergen of the Year." Women are more likely to have pierced ears, which can facilitate a sensitivity to nickel if earrings containing the metal contact broken skin. But men are closing the gap due to the popularity of body piercing.

What's Causing Your Rash?

IT'S LIKELY AN ALLERGY IF:

You've had past skin reactions to metal
Reaction is delayed and persists after you remove the ring
Ring tests positive for nickel

IT'S LIKELY AN IRRITATION IF:

Reaction occurs quickly
Reaction resolves if you keep your finger clean and dry
Ring tests negative for nickel

As with other allergies, a reaction to nickel can develop seemingly out of the blue, even years after a person's first exposure. Once the allergy is triggered, it will persist lifelong. A reaction to a particular piece of jewelry may occur suddenly because nickel salts tend to come to the surface years later, or after protective coating has worn away. "You get more exposure to nickel the older the piece of jewelry is," says Jeffrey Benabio, a dermatologist with Kaiser Permanente in San Diego. "That's why you can wear a ring for 20 years and suddenly it starts causing problems."

"One day, your body just rebels," says Geri Koeppel, 42, a freelance writer in Phoenix who had worn her white-gold wedding ring for two years when it started burning. "It looked like my finger had been branded by my ring," she says. The firey red irritation didn't heal for a year, and she didn't wear a ring or any jewelry for six years until she found a platinum ring that didn't bother her.

Because it's strong, cheap and lustrous, nickel is commonly found in costume jewelry, watch backings, belt buckles and jeans rivets. Dermatologists frequently see the telltale red bumps on patients' abdomens or necks. Areas where sweating occurs can become particularly irritated, because the salt in sweat causes metal to corrode, increasing the nickel exposure.

A Cellphone Allergy?
Nickel is even used in some cellphones and has been known to cause irritations on users' ears and faces—a phenomenon dubbed "mobile-phone dermatitis." In a study published last year in the Canadian Medical Association Journal, researchers at Brown University tested 22 mobile-phone models and found nickel in 10 of them, mostly on menu buttons and company logos.

To cut down on allergic reactions, the European Union severely restricted the use of nickel in jewelry in 2001 and cellphones last year.

Suggestions by some dermatologists to follow suit in the U.S. have gone nowhere—in part because nickel is so prevalent, particularly among imports.
Many gold- and silver-plated jewelry pieces use nickel bases, or small quantities of nickel used in hardening alloys. Nickel is what makes white gold white, and it's frequently added to gold that's less than 14-carat. "This can lead to the dreaded 'He-got-me-a-cheap-wedding-ring-that-turned-my-finger-black' syndrome," says Eric Larsen, editor of Nickelfreelife.com, which provides allergy information and links to nickel-free jewelry and tools. But he adds that some jewelers aren't even aware that their products contain nickel. "Many suppliers I have spoken to have not even thought of asking the question of their suppliers. It is very important to use a jeweler that is involved in the sourcing of their product," he says.
Even jewelry that is billed "nickel-free" may merely have a nickel-free coating over a nickel base, says Michael Dow, owner of Athena Allergy, a Huntersville, N.C., company that markets a Nickel Alert® kit online. If a cotton swab dipped in a chemical (dimethylglyoxime, or DMG) turns pink when placed against an object, it contains at least some nickel.

The Nickel Coin Test
A dermatologist can perform a patch test to determine whether you are allergic to nickel. Mr. Dow says you can also do it at home by taping a nickel coin (which is 25% nickel) to the inside of your arm for 48 hours. If you are allergic, a red rash will appear 8 to 24 hours after you remove it, he says.

The rash from a nickel allergy can be treated with a topical steroid cream and by avoiding contact with the material again.

If you don't want to give up your nickel-containing wedding ring, one remedy is to coat it with a clear nail polish that can form a temporary barrier. Mr. Dow's company also makes Nickel Guard® which is like clear nail polish but is made to bond with metal and lasts longer. A jeweler may also be able to seal the ring with rhodium or another protective coating. But none of these remedies last forever.

One home remedy suggested on various Web sites—boiling the jewelry in vinegar and peroxide—may remove nickel salts from the surface, as might cleaning the ring with jewelry cleaner. But, says Mr. Dow, "15 minutes later, those nickel salts will percolate to the surface again."

Safe Metals
Nickel isn't the only metal that can cause allergic reactions, although others are much rarer. Doctors are increasingly finding allergies to palladium, a platinum-like metal that is gaining popularity. Platinum itself is generally considered safe from allergies, as is 24-karat gold, sterling silver and stainless steel. But even those are occasionally mixed with nickel, or seem to cause allergic reactions on their own.

No matter what a ring is made of, it can cause a different kind of irritation due to a build-up of soap, detergent, toothpaste—anything else that comes into frequent contact with your hands. Irritant Contact Dermatitis, as it is officially known, occurs when the skin's normally protective layer is worn away. Because rings often trap moisture, this wearing away can happen easily to that circle of skin. "Soap is an irritant. It can stay on your finger for hours," says Dr. Benabio. "And everybody is washing their hands more with the flu around." Using an alcohol-based sanitizer may be less irritating, because the alcohol evaporates quickly. ("Unless your hands are really raw and irritated—then the alcohol can sting," he notes.)

Bring Out the Lotion
A channel-set ring, with small holes behind the stones, can be particularly problematic, Dr. Benabio says, since it tends to trap moisture and soap. He suggests rinsing and drying your hands very carefully, and applying a lotion that has a protective barrier like Eucerin. If the redness does not return, you are probably not allergic to any of the substances in the ring and keeping your hands dry and protected will probably solve the problem.

Even if your problem is a metal allergy, it's important to keep your hands dry, experts say, since moisture can cause nickel to react with skin. Dr. Benabio has one more piece of advice for anyone suffering wedding-ring dermatitis: "Make sure your spouse does the dishes."
HEALTH JOURNAL DECEMBER 15, 2009

Currency

Wedding Ring Dermatitis - Article by Wall Street Journal