Everything Bothers my Ears! What You Need to Know about Contact Dermatitis
Many metals are used for jewelry, both precious and non-precious, but which metals are best for our skin and how do we know? Skin problems with jewelry metals are so common that nearly everyone has had, or knows someone who has had a jewelry rash, or an infection, or some sort of skin reaction to a piece of jewelry. These problems medically go under the term “contact dermatitis,” and it is important to ask the question: Does jewelry cause these skin problems? The answer is no, but unfortunately, also yes. Everything depends on the type of metal used in the jewelry. Whether the metal is in an earring wire, a post in a body piercing, or simply part of a piece lying in close contact with the skin, the wrong metals can cause contact dermatitis. Not everyone is affected by these problems, but many are, and some who have never had problems may develop them later in life. So, as a jewelry designer, seller, or customer, it is important to know what current reliable research has to say about rashes or contact dermatitis from jewelry.
“Contact dermatitis” can be anything from a mild rash to a persistent itching to a corrosive blistering or outright open sores which can become infected, due to contact with an allergenic or irritating metal when it touches the skin. While it may seem obvious to some, any skin that has been broken, or is thinner (such as the skin in a piercing) will likely be much more sensitive to an allergic metal reaction and possible infection. It is important for customers and wearers of jewelry to know which metals are used in the ear wires or piercing posts that penetrate the skin. That being said, itchy skin and irritation can also occur from metals in the main part of a jewelry piece which is simply lying on or touching the skin—often skin that is thin and easily irritated (e.g. the neck, behind the ears, in between the fingers, on the inside of the ankles, and on the undersides of the arms and wrists.)
The most common cases of contact dermatitis with jewelry come from anything containing the metal nickel. Nickel allergies are so common, and so well-documented that many countries have laws regulating the manufacture, sale and packaging of any nickel-laden metals which will be in close contact with people’s skin (eyeglasses, sunglasses, jewelry, braces, or implants.) In the US and UK, we have a labeling system which allows companies to label jewelry and decorative items as “nickel free.” But there is a problem with the interpretation of what constitutes “nickel free.” It is a simple fact that earring posts and other piercings labeled “nickel free” often contain some nickel, just reduced amounts of it. This reduced amount can still cause terrible reactions in those who are sensitive to this metal. Another term that can mislead buyers is “hypoallergenic.” This word is basically meaningless, and only indicates that something is less likely to cause allergies. But since there is no comparison or data to back this word up, it should be ignored unless you have no sensitivity at all.
One of the worst metals for jewelry in terms of allergic reaction, is the so-called “german silver” which is not silver at all (and not really german either) but is merely nickel combined or alloyed with other metals. In addition, much costume jewelry and piercing jewelry may contain some amount of the metals cobalt or chromium, which are also proven factors in many allergic reactions. (See: Diagnosis And Management Of Contact Dermatitis, http://www.aafp.org/afp/2010/0801/p249.html)
Many jewelry wearers or piercing customers who become aware of contact dermatitis will then look to make sure that all jewelry is either stainless steel or sterling silver. But a close inspection of the ingredients of both of these metals shows that both can be alloyed with or mixed with nickel, and cobalt or chromium. With sterling silver, you have to know the source to be sure of the contents, and unless your jewelry vendor or designer knows his suppliers well, there is no real way to know what is contained in the earring or piercing posts you are buying. Some would argue that properly hallmarked (which is the practice of stamping metals according to their contents) silver can solve these problems. By clearly labeling the contents, they say, you know what you’re really getting. But this is not always the case. as early as the 1960’s, good papers were being published in the Journal of American Medicine and other publications, showing that as more than half of a typical study group with sterling silver piercings would develop some sort of dermatitis or reaction. Again, some sterling silver can contain nickel, and the supplier or refiner must disclose the contents of the metals they sell. But whether or not the designer, manufacturer and ultimately the retail vendor or seller will know and disclose this is anyone’s guess. In short, buying jewelry sight unseen is probably not a good idea unless you have very good disclosure, proper labeling, and reliable sources.
Many people then, having had problems with some sterling silver, will opt for gold, thinking that surely gold doesn’t cause dermatitis. We have all heard of people who claim to only be able to wear gold of a certain karat content. But we must be very careful when thinking that buying gold will alleviate all risk of rashes or dermatitis. Firstly, not everything labeled gold actually is. Gold plated or gold filled jewelry is definitely not gold, and often contains a great percentage of base metals such as copper (which can cause irritation in some) and nickel. Most costume jewelry is either gold plated or gold-filled and is simply base metal jewelry which has been electroplated with a thin layer of gold which comes off with wear. These base metals can cause irritation of the skin without even being in contact to a piercing or place where the skin has been broken. White gold is a mixture of gold and silver and other metals, nickel usually among them. But there have even been well-documented cases of pure gold, or 24 karat gold causing contact dermatitis (See: http://www.ncbi.nlm.nih.gov/pubmed/10826096.) An even greater risk is paying for what you believe to be gold and finding out either from the rash you get or from an appraiser that what you have is not really gold. I have seen many “gold” pieces hallmarked with various karat counts that were purchased cheaply in markets (often but not always outside of the US) that simply turned out to be fakes.
Oddly enough, fine silver (defined as 99.9% pure silver) is one of the very few metals which show no problems with allergic reactions, infections, or contact dermatitis. Another metal favored by jewelers and that is being used with increasing frequency for it workability, strength, and lack of risk for dermatitis is the metal titanium. (See: http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1497.1999.00357.x/abstract.) It is no coincidence that titanium is the metal favored by surgeons for implants and pacemakers. There is no evidence that titanium has ever caused allergic reactions in the body, not even when it is inside the body or in contact with its mucosal membranes, and reports of reactions point to some coating or alloy as the cause, rather than the titanium. Niobium is another metal that has proven to be safe, and it is also used increasingly in the jewelry world.
There are many good sources for information on jewelry rashes and metal allergies, including the American Academy of Dermatology (http://www.aad.org/.) Consulting a dermatologist is a very good idea if you have ever had skin problems from jewelry. These issues can be minimized by keeping careful track of any jewelry that causes problems with your skin. (See: http://dermatology-s10.cdlib.org/144/commentary/contact_dermatitis/katta.html.)
But to prevent contact dermatitis from jewelry, you need to demand good information about any jewelry you buy. The only way to be absolutely sure of what is in your jewelry is to deal with jewelers or designers that know their suppliers and will disclose their contents to you. Jewelers and designers that use solid metals or alloys whose complete content is known can be trusted to produce jewelry that will not cause contact dermatitis. If a seller or manufacturer or designer of jewelry cannot or will not answer your questions about the content of the metal, then you need to find one who is more forthcoming.
At Ann Summers Jewelry, we buy directly from precious metals refiners and manufacturers, as well as from several other wholesale refiners and producers who give full disclosure of each precious metal product they sell. We label everything we make, and are happy to answer any questions you might have about a piece. If contact dermatitis from jewelry is a problem for you, we are happy to customize a piece for you that will minimize any rashes or irritation. We buy only solid metals (those which have the same pure metal throughout, and have no coatings, filling, or electroplating), and use only nickel free sterling silver, fine silver, and titanium for our ear wires. We use no base metals such as copper, nickel, or stainless steel in anything we make, because we want our customers to be free to buy what they like without worrying about contact dermatitis.