Letter to the Editor

| August 1, 2018

Funding: No funding was provided.
Disclosures: The authors have no conflicts of interest relevant to the content of this article.

Brassiere Clasps are a Source of Nickel Exposure 

Dear Editor:

Nickel sensitization has been repeatedly associated with piercings and jewelry exposure in both women and children.1 We report a case of an allergic reaction to a nickel brassiere clasp, a commonly seen, yet underreported, source of nickel sensitization.

Case report. A 32-year-old woman was evaluated for a two-year history of intermittent hand dermatitis. Patch testing was performed according to the North American Contact Dermatitis Group (NACDG) standard screening series. The patch tests were removed and evaluated 48 hours after placement. Erythema and scattered discrete papules were noted on her back at the site of the nickel patch placement. She again returned 72 hours after application for evaluation, and the intensity of the reaction at the site of nickel application had increased in erythema and induration with more papules. Furthermore, at this 72-hour preliminary read, the patient was noted to have developed erythematous papules coalescing into a plaque between her breasts, which was not present at the 48-hour reading (Figure 1). At the 96-hour (delayed) reading, the patient was determined to have a 2+ reaction to nickel (there was notable erythema, induration, and microvesiculation of coalescing papules) and worsening of the plaque between her breasts. Notably, we questioned her about her exposures, specifically front-clasping bra hooks, which she stated she had not worn in 10 years due to previous reactions to the clasps.  The patient adhered to a nickel avoidance regimen (including wearing brassieres with plastic fasteners), and had significant improvement of her hand dermatitis.  Notably, at her two-year follow up, the dermatitis on her chest had not recurred.

Summary. Our patient experienced an “ectopic-recall” flare reaction during patch testing at a preexisting site of dermatitis, which helped to confirm the relevance of her positive patch test.  This case highlights the need to consider metal brassiere clasps as an underreported source of nickel exposure and exemplifies the importance of “ectopic-recall” flare reactions.2

With regards,

Sharon E. Jacob, MD, and Elise M. Herro, MD 

Dr. Jacob is Professor of Dermatology at Loma Linda University in Loma Linda, California, and Dr. Herro is a dermatologist at the American Skin Institute in Los Angeles, California.

References

  1. Thyssen JP, Linneberg A, Menné T, Johansen JD.  The epidemiology of contact allergy in the general population—prevalence and main findings.  Contact Dermatitis. 2007 Nov;57(5):287–299.
  2. Chapman MS, Zug KA.  Generalized pustular reaction and ectopic flare of dermatitis caused by patch testing.  Am J Contact Dermat. 2002;13(2):83–84.

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