Thursday, May 14, 2009

STI: Scarred by nickel

May 14, 2009

Doc talk

Scarred by nickel

By Dr Jean Ho 


It was the place schoolgirls flocked to for ear-piercings and pretty earrings: a corner jewellery store in a shopping mall in Orchard Road.


I was one such schoolgirl, but that was a long time ago.


To an adolescent, ear-piercing is a rite of passage to adulthood, a major decision made entirely on her own. Goodbye, chunky clip-on earrings.


Yet, who would think that something so seemingly innocuous could cause problems such as infections, keloid scars and skin allergy?


The procedure is often carried out with an ear-piercing gun. For hygiene purposes, most guns now come in pre-sterilised, single-use packs to minimise the chance of cross-contamination of blood or body fluids.


However, infection can still occur if you don't follow the aftercare protocol properly. This is most crucial in the first two weeks when the skin is recovering.


An infection shows up as pain, swelling or foul-smelling discharge oozing from the puncture site. In some patients, a scar forms at the site of piercing. These keloid scars can grow to significant and disfiguring proportions. Those who are prone to such scars should not even contemplate ear piercing.


Infection and poor healing of the skin after piercing also increase the chance of scar formation. The scars can be treated with injections, laser or surgery but there is no guarantee that keloids will not form again.


A third but little known risk of ear piercing is the development of a skin allergy, in particular to the metal nickel.


One day, TL, a 15-year-old girl, came to see me and lamented: 'Every time I put on my earrings, I get itchy around my earlobes and my neck goes crazy with a rash when I try to wear my necklace. Do I have to give up on jewellery?'


Absolutely not. This is a classic case of nickel allergy. One can still wear jewellery, but not those with nickel.


This ubiquitous metal, encountered in everyday life, lurks in the most unsuspecting of objects such as belt buckles, clothes fasteners, coins, keys and wrist watches. For instance, that stubborn itch just below the belly-button may be an allergic reaction to the metal stud on your jeans.


The diagnosis of a nickel allergy can be confirmed with an allergy patch test, although this is rarely done if the history is highly suggestive.


'Isn't nickel found only in cheap costume jewellery? But my earrings are 14-karat gold,' said the patient.


Unfortunately, even 14-karat gold (especially white gold) has leachable nickel, that is, nickel which can be drawn out by sweat, water and detergents. When buying gold jewellery, ask for 18-karat gold which is nearly free of nickel impurities.


Silver jewellery may also contain nickel unless it is sterling silver of the purest grade. Jewellery made from stainless steel is the safest as far as nickel allergy goes. Although stainless steel contains nickel, this metal is so tightly bound into the alloy that it cannot escape to wreak havoc on the skin.


One is not born with a nickel allergy. It develops later in life, influenced by previous exposure to the metal, and ear piercing is perhaps the biggest culprit.


During piercing, the skin is punctured and a metal post is inserted into the hole. As the nickel from the post comes into contact with raw skin, the body mounts an immune response and locks on to the metal, remembering it as a foreign body.


Antibodies develop to nickel and the next time it is encountered, the skin is ready to launch a full-scale offensive, that is, an itchy, blistering allergic reaction.


If the problem goes unrecognised and untreated, the allergy becomes harder to treat and the affected skin eventually develops a dirty-looking pigmentation.


So, always ask for posts like stainless steel or 18-karat gold when getting your ears pierced. These earrings may cost more than regular ones but this is a small price to pay for a life free of the misery and inconvenience of a nickel allergy.


While stainless steel does contain nickel, the metal is bound tightly to others, making it difficult to be released.


On the other hand, 18- and 24- carat gold is nickel-free although 9-carat gold can contain nickel and should be avoided. Gold allergies are rare.


As for that favourite pair of 'costume jewellery' earrings, they need not be condemned to the back of the drawer. Simply brush a few coats of clear nail polish on them before putting them so that the metal does not touch the skin. Do not wear the earrings longer than a few hours. A backing material, fashioned from fabric, can be used to cover the metal surfaces of studs, buttons and watch straps.


I gave TL a cream which settled her rash and itching promptly. However, a nickel allergy does not go away and a 'cure" is only possible with strict avoidance. Anything shiny or metallic should be regarded with suspicion until proven otherwise.

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