What is it?

Systemic nickel allergy syndrome (SNAS) is an inflammatory skin condition, caused by a type IV hypersensitivity reaction, that occurs after recurrent contact with nickel. Nickel is a chemical element largely diffused in the environment. The most common presentation of nickel allergy is allergic contact dermatitis. Still, in some sensitized subjects, nickel can provoke dermal symptoms regardless of the immediate skin contact. Some also suggest that SNAS is linked with extra-cutaneous symptoms such as respiratory, gastrointestinal and neurologic findings.

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Systemic Nickel Allergy Syndrome (SNAS).

Additional names

This group contains additional names:
- Allergic contact dermatitis
- Atopic neurodermatitis
- Besnier prurigo
- Diffuse neurodermatitis of Brocq
- Discoid atopic dermatitis
- Erythrodermic atopic dermatitis
- Flexural atopic dermatitis
- Follicular atopic dermatitis
- Pruriginous atopic dermatitis
- Strachan's syndrome

Signs & symptoms

SNAS has cutaneous manifestations including contact dermatitis, pompholyx, hand dermatitis, dyshydrosis and urticaria. In its chronic course it's systemic symptoms include headache, fatigue, asthenia, and gastrointestinal symptoms such as nausea, vomiting, recurrent apthosis, abdominal pain, bloating, constipation and diarrhea.

Diagnosis

Doctors can usually diagnose SNAS based on the patient's skin appearance and a recent exposure to nickel. For a final diagnosis, a patch test may be recommended. During a patch test very small amount of allergens are placed on the patient's back and covered by patched. Two days later, the doctor will examine the area and if a nickel allergy is present- the specific patch will be inflamed. Patch tests are safe because of the small amount and low concentrations of the allergens that are used. Also, an improvement after a restricted diet can also assure the diagnosis. Lab tests may include eosinophilia or elevated IgE levels.

Treatment

The allergy cannot be cured so avoiding objects that contain nickel is recommended. For skin manifestations lotions and creams can help as well as topical corticosteroids. Oral corticosteroids and antihistamines might be prescribed. If it doesn't get better, phototherapy might be recommended for some months.

☝️ This is not a substitute for professional medical advice. Please consult with your physician before making any medical decision.

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