Nickel dermatitis from earrings 15 years after EU directive implementation: a clinical-epidemiological study and a market survey in Rome, Italy

J Eur Acad Dermatol Venereol. 2019 Oct;33(10):1928-1934. doi: 10.1111/jdv.15650. Epub 2019 Jun 17.

Abstract

Background: Nickel (Ni) dermatitis remains a highly prevalent allergic condition in Italy. There is a continuous need for clinical and epidemiological surveillance to evaluate whether or not European Ni Directive has been effective in contact allergy prevention.

Objectives: To assess the prevalence of Ni dermatitis among patch-tested patients and self-interviewed school students and to analyse Ni release from earlobe jewellery.

Methods: Results of patch tests performed in 2006-2007, 2015-2016 and 2017-2018 were retrieved. A questionnaire was compiled by 315 secondary school students. Ni release from earring parts was analysed with the EN1811:2015 method.

Results: A significant time trend of decreasing Ni positivity from 2006-2007 to 2017-2018 was observed both in the overall population (44.1% in 2006-2007, 33.0% in 2015-2016, 31.6% in 2017-2018, P < 0.0001) and in female patients (P < 0.0001). Conversely, change was not significant in males (P = 0.16). Decrease was significant for all age groups, except for those aged >60 years (P = 0.51). Among 242 students who reported earring use, 130 (54%) reported symptoms at earlobes, mostly associated with jewellery of materials other than gold and silver (59% of those with earlobe symptoms). Ni release exceeded the migration limit in 4/21 (20%) earring parts.

Conclusions: A high prevalence of Ni dermatitis and earlobe symptoms were found in Rome. A decreasing time trend was noted, with a significant decline in Ni sensitivity compared to the situation observed right after Ni Directive implementation. This most likely represents the consequence of reduced Ni content in earring parts, although a major care in the use of Ni-containing objects could contribute to explain these findings.

MeSH terms

  • Adolescent
  • Adult
  • Dermatitis, Allergic Contact / epidemiology*
  • Dermatitis, Allergic Contact / etiology*
  • Dermatitis, Allergic Contact / prevention & control
  • Ear Auricle
  • European Union
  • Female
  • Humans
  • Jewelry / adverse effects*
  • Jewelry / analysis
  • Legislation as Topic
  • Male
  • Middle Aged
  • Nickel / adverse effects*
  • Nickel / analysis
  • Patch Tests
  • Prevalence
  • Rome / epidemiology
  • Sex Factors
  • Surveys and Questionnaires
  • Young Adult

Substances

  • Nickel