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What's the rash under this 27-year-old woman's wedding ring?

This 27-year-old woman presents with a rash under her wedding ring. She is very concerned  that she has developed an allergy to her wedding ring containing platinum/gold. What is your diagnosis?

Case of the Month

Diagnosis:

Irritant eczema from trapped detergent.

 

Discussion
In the vast majority of cases where patients come in with a dermatitis located under their rings, the cause is irritant eczema from trapped detergent. If you look carefully at these rings, many have channels where the stones are set in the ring. These channels are excellent traps for harsh detergents, which over time can build up and cause irritation. In these cases, I recommend that they have their rings cleaned professionally and then also they have to remove them any time they wash their hands in the future. I also warn them that they have to be meticulous about retrieving the rings when they’re done. I have had a few patients who at restaurants or sporting events have left their rings on the shelf in the bathroom. I use a topical class 1 or class 2 anti-inflammatory agent twice daily for three to five days, and the irritant eczema will resolve. If for some reason these measures don’t help, then I would consider initiating patch testing for nickel allergy. Nickel is a very inexpensive hardening metal that is added to almost all metals, including gold and platinum, to increase hardness. Even in rings that don’t contain channels for stones, detergent can get trapped under the ring against the skin.

In summary, the vast majority of cases of ring finger eczema are related to detergent irritation under the ring and not a true allergy to any of the metals in the ring.

 

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