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10 year old boy with a rash on his abdomen. What is your diagnosis? 

Diagnosis:
Nickel Allergy
10 year old boy with a rash on his abdomen.

This usually manifests as rash on the lower abdomen as a manifestation of nickel found in many of the clasps and snaps associated with pants and jeans, the earlobes associated with the wearing of earrings containing nickel and on the wrists with metal (nickel containing) components of watch bands and clasps.

It has been my experience that the vast majority of patients with nickel allergies also have atopic eczema.

Treatment:
The main treatment is the removal of the offending agent, and I like to use topical class 4 steroid ointments daily for 10 to 14 days. A pearl on this one is that the metal clasp on jeans can't be covered with cloth or fingernail polish because the metal will actually leach through both of these and still cause a reaction. I recommend that the parents take all the pants to a tailor and have the metal buttons removed and replaced with gray plastic buttons. This almost always solves the condition. Also be aware of large belt buckles. These too can cause a similar condition and once again belt buckles should be made out of plastic.

Examples of nickel allergies
Here are some additional examples of nickel allergies from buttons on jeans, ear rings, and nickel containing metal in watch bands.

Also presented is a rash on the fingertips of a custodian. It occurred only on his right hand. After allergy testing, we noted that he was positive for nickel allergy. After discussing with him common items that contain nickel that he might encounter (such as door handles, eating utensils, keys, etc.) he then had a "Eureka" moment. He said that he kept his custodial key chain, full of keys, in his right front pocket and played with them throughout the day as a form of habit. Once he took the keys out of his pocket and stored them in his desk, the fingertip eczema went away!
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Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
At the
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology
www.CrutchfieldDermatology.com

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