Low Nickel Diet: A Patient-Centered Review

Nickel allergic contact dermatitis (ACD) has become a more widely recognized disease process over the last three decades in the United States. A subpopulation of ACD patients will manifest with systemic contact dermatitis (SCD). Specifically, those cases of widespread recalcitrant nickel ACD with only partial clinical relief after strict nickel avoidance, suggest SCD. Evidence indicates that application of the low nickel diet has the highest efficacy in patients with SCD, and that a targeted, points-based approach is most meaningful. Furthermore, as the immunologic pathways of how oral nickel provokes cutaneous dermatitis are complex, involving interplay between the Th2 and Th1 response, more specific investigative work in this area is much needed.