Nickel allergy became a serious social problem. Daily contact with nickel-containing items such as cutlery, crockery, home appliance, jewelry, metal elements of clothing, eyeglasses frames, coins, nickel-containing tools causes frequent skin exposure to this metal [1-3]. The result for sensitive skin is allergic contact dermatitis. Contact dermatitis, also known as eczema, is inflammation of the skin which is characterized by a large number of clinical symptoms, e.g. itching, burning, redness, flaking of the skin, appearance rashes including blisters. Chronic cases manifested by cracking, hyperkeratosis and lichenification [4].
According to the Eurostat’s reports (European Statistical Office) and Eurogip (French information agency about labor protection at the European level) the losses due to occupational skin disease are approximately 3 million working days, and amount to about 600 million euros per year [5]. In the European Union dermatitis are the second most common occupational diseases [6,7]. Hairdressers, cashiers, beauticians, health care professionals, guitarists and people working with metal objects are the most exposed for nickel allergy. Data collected by BLS (Bureau of Labour Statistics) show also the some statistics in the United States. According to the NIOSH (The National Institute for Occupational Safety and Health) total annual cost, including sick leaves and decrease in labor productivity, is 1 billion dolars [8]. In Poland, according to the 2007 data of Ministry of Labour and Social Policy, occupational diseases of the skin are located on the 6th place of the total number of occupational diseases [9].
According to the Central Registry of Occupational Diseases run by the Institute of Occupational Medicine in Lodz contact dermatitis constitute 81.6% of all occupational skin diseases in Poland and it is the main cause of claims for damages [10]. In turn, according to the data of the Department of Statistics of the Social Insurance Institution, the number of sick leaves caused by skin disease in 2007 has reached 198 thousand (absenteeism for this reason – 1865.7 thous. days) [11].
Nickel is one of the most common allergen responsible for contact dermatitis, because it is found everywhere in the environment. The study showed this allergen was the leading cause of response among hospitalized patients due to contact allergy in the Clinic of Dermatology and Venereology of the Medical University in Warsaw [12] and Bialystok [13]. Statistical study showed also nickel more often sensitizes women which is due to the wearing of metal jewelry [14,15]. Moreover, nickel causes more cases of allergic reactions than in total all other metals [16]. The symptoms of nickel allergy occur up to 48 hours after exposure to the products containing this metal, however very often the skin lesions appear immediately. The symptoms persist about 2-4 weeks and they are located in a place directly contact of skin with allergen. Rarely they appear in areas not exposed to nickel [17]. The importance of nickel allergy proves introduced in 2001 in the European Union Directive 94/27/EC laying down the conditions for the nickel-containing products which are in direct and prolonged contact with the skin.
In Europe, as well as in the United States of America data about nickel allergy have been collected since 20 years. The ESSCA (The European Surveillance System on Contact Allergies) is engaged in problem of this allergy in Europe and monitoring increasing rates of nickel allergy in 9 selected counties. According to the ESSCA the highest percentage of people with nickel allergy is observed in Italy (31.7%), and the lowest is in Denmark (8.1%) where restriction on exposure to this metal have already begun in 1992 [18]. According to the data of the NACDG (The North American Contact Dermatitis Group) nickel is allergen which causes most often the positive response [19], and the number of people with this allergy in America in recent years has increased from 14.5% (1992-1995) to 18.8% (2003-20014) [20].
The problem of nickel allergy affects also population of Asia (Singapore – 19.9%, China – 23.1%, Taiwan – 23%, Japan – 30%) and Africa (Ethiopia – 40%) [21-23]. The most important risk factors of development of nickel allergy are sex and age. Demographic trend of nickel sensitivity is the same for both Europe and the world – predominance among the women and people in the period of professional activity between 30 and 60 years old [24]. Epidemiology of nickel allergy on selected European countries (Denmark, Germany, Italy and United Kingdom) are shown in Table 1, and Figures 2, 3.
|
Sex |
Denmark |
Germany |
Italy |
United Kingdom |
|
Women |
64,6 |
62,2 |
67,1 |
67,1 |
|
Men |
35,4 |
37,8 |
32,9 |
32,9 |
Figure 2. Demographics of nickel allergy depending on the age of women – general trend [24].
Figure 3. Demographics of nickel allergy depending on the age – without distinction of sex [24].
Despite the introduction of regulation concerning acceptable amounts of nickel in products containing this metal (Directive 94/27 / EC), there is still observed an increase percentage of people suffering from nickel allergy. This is due to insufficient supervision and inconsistent enforcement of the law. This leads to trading uncertified products on the market [25]. In addition, the problem is intensified by non-existence of method of nickel allergy therapy, and limited choice of effective preparations against nickel allergy symptoms [26].
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[3] Uter et al., Contact Dermatitis, 2005, 53, 136.
[4] Beers, Berkov, The Merck Manual. Podręcznik Diagnostyki i Terapii, URBAN & PARTNER, Wrocław 2001.
[6] HSE Guidance Notes: Medical aspects of occupational skin disease, HSE, London 2004.
[7] Diepgen, Int Arch Occ Env Hea, 76, 331.
[8] Kütting, Drexler, Int Arch Occ Env Hea, 2003, 76, 253.
[9] Polish Ministry of Labour and Social Policy, Assessment of safety and health at work in 2007 in Poland, MLSP, Warsaw 2008.
[10] http://www.imp.lodz.pl/.
[11] http://www.zus.pl.
[12] Rudzki et al., Przegl Dermatol, 2000, 87, 103.
[13] Reduta et al., Przegl Dermatol, 2002, 89, 193.
[14] Toms, Eur J Orthod, 1988, 10, 87.
[15] Kerosuo et al., Am J Orthod Dentofacial Orthop, 1996, 109, 148.
[16] Bass et al., Am J Orthod Dentofacial Orthop, 1993, 103, 280.
[17] Szeląg, Dent Med Probl, 2002, 39, 309.
[18] Uter et al., Contact Dermatitis, 2005, 53, 136.
[19] Pratt et al., Dermatitis, 2004, 15, 176.
[20] Rietschel et al., Dermatitis, 2008, 19, 16.
[21] Thyssen, Contact Dermatitis, 2011, 65, 1.
[22] Goon, Goh, Contact Daermatitis, 2005, 52, 130.
[23] Sakanashi et al., Confocal Laser Microscopy – Principles and Applications in Medicine, Biology, and the Food Sciences, InTech, Croatia 2013.
[24] Garg et al., Br J Derm, 2013, 169, 854.
[25] Thyssen et al., JEADV, 2011, 25, 1021.
