For the estimated 82 percent of women with pierced ears, earrings are an important fashion accessory that many women wear, and change, daily. However, a new study suggests that women may be getting more than they bargained for when purchasing inexpensive earrings. Nickel exposure from these earrings is a common cause of dermatitis on the earlobes and repeated exposure can make treatment difficult.
Dermatologist Howard I. Maibach, MD, FAAD, professor of dermatology at the University of California, San Francisco, has presented evidence that nickel exposure from inexpensive earrings purchased from various stores and vendors is frequent in the United States and does not correlate with the price of the earrings within the "inexpensive" price range.
“Sensitization to nickel is quite common in the United States, with studies estimating that 5.8 percent of American adults tested positive to nickel allergy through a routine skin test,” said Dr. Maibach. “In the early 1990s, the European Union Nickel Directive was passed in an effort to decrease the prevalence of nickel sensitization in consumer and occupational products in Europe, with results indicating the directive is working. However, no such regulations exist in the United States to limit nickel exposure – leaving millions of people at risk for dermatitis from common goods, such as earrings.”
For the study, Dr. Maibach and his collaborator, Jacob Pontoppidan Thyssen, MD, purchased inexpensive earrings from 34 different stores and artists in San Francisco in October 2007. Inexpensive earrings were classified as those under $50; in contrast, expensive earrings were classified as those made of gold or platinum available from fine jewelry stores. A total of 277 earrings were purchased from four different categories of vendors – a downtown market with licensed local artists producing custom-made jewelry; jewelry stores in China Town targeting mainly tourists; national and international clothing and accessory chain stores targeting mainly girls and women under age 40; and similar stores targeting mainly women over age 40.
All earrings purchased were examined with the dimethylglyoxime (DMG) test – a routine spot test using solutions to detect the presence of nickel and other alloys. Of the 277 earrings that were tested, 85 (or 30.7 percent) demonstrated at least one spot that tested DMG-positive for nickel. Dr. Maibach noted that the highest proportion of DMG-positive earrings was purchased from local artists, with 69 percent of these earrings testing positive for nickel. A large portion (42.9 percent) of earrings purchased from stores in China Town also tested positive for nickel.
When the number of DMG-positive earrings was examined from accessory and clothing stores targeting younger women under age 40 and those stores targeting women over age 40, Dr. Maibach found a large discrepancy. Specifically, 24.1 percent of the earrings purchased at the stores targeting younger women tested positive for nickel; whereas only 1.7 percent of earrings from stores targeting women over 40 tested DMG positive.
“Except for one store targeting girls and young women where a significant number of DMG-positive earrings were found, the proportion of earrings that tested positive for nickel was generally higher among individual China Town stores and local artists than in individual national and international chain stores,” said Dr. Maibach. “We also found no correlation between the country where the earrings were manufactured and the frequency of DMG-positive reactions or whether the price of the inexpensive earrings correlated with testing positive for nickel exposure.”
Dr. Maibach added that in one accessory store, none of the 44 earrings priced between $5 and $8 were DMG positive, whereas numerous earrings priced between $15 and $25 in another accessory store were DMG positive.
“From our findings, we could not establish a ‘safe-limit price’ as a guide for consumers who want to avoid excessive nickel exposure when purchasing inexpensive earrings,” said Dr. Maibach. “But it’s safe to say that young customers purchasing earrings at a considerable price range in U.S. chain stores are potentially at risk of nickel exposure and sensitization.”
Studies show that nickel sensitization increases the risk of hand eczema, but Dr. Maibach argued that avoiding nickel – which is found almost everywhere – can be difficult. He acknowledged that there are some patients with nickel dermatitis who refuse to give up their jewelry, even when they know it is the cause of their condition. Since the best way to avoid nickel sensitization and subsequent dermatitis is to prevent nickel exposure, Dr. Maibach suggested the following tips:
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