North Shore Boston MD Free Forum: November 2008

Do you have a child/ grandchild with facial rash ?
Does she use a cell phone ?

Did you ever think why the hell she gets a rash after using cellphone ?

Did you change her telephone two, three times ? But she gets the rash no matter what telephone she uses.

Did you send her to a dermatologist ?
Did you have her use a lot of steroid creams ?

Until it happens to some one close to you, you will not realize how important this is.

I am sure I am not the only MD with some one in the family with cell phone allergy.

I thought I will share my experience with you.

See attached : this was published this year. Almost none of us know about it.

Take one look at the picture and make the diagnosis, please.

So what do you do ?

After investigations we found Nokia phones do not have any nickel in it as it says in table 1. After spending some money on other phones once we found the answer and switched to Nokia phone the facial skin got back to normal.

Thought this will help some one in my 100 MD net work study group. I hope most people in my group benefit from these educational pieces and each of you is better off after reading these, than before reading these.

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CMAJ • January 1, 2008; 178 (1). doi:10.1503/cmaj.071233.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
from JOURNAL OF CANADIAN MEDICAL ASSOCIATION- CMAJ JAN 1, 2008

Teaching Case Report

Cellphone contact dermatitis with nickel allergy

Lionel Bercovitch, MD* and John Luo
*Department of Dermatology, Warren Alpert Medical School of Brown University; Liberal Medical Education, Brown University, Providence, Rhode Island

The case: An 18-year-old male presented with pruritic lichenified dermatitis on his lower abdomen and eczematous dermatitis on his extremities, flanks and face that had lasted several weeks. We suspected his belt buckle had led to allergic contact dermatitis with subsequent autoeczematization. Patch testing using the expanded North American Contact Dermatitis Group allergen battery of 65 allergens1 disclosed an edematous and papulovesicular reaction to nickel at 72 hours. The patient had no other positive reactions, nor did he react to other metals tested, including gold, cobalt, chromium, copper and palladium.

The patient suspected that his recurrent facial dermatitis was related to contact with the headset of his cellphone. We spot tested both the antenna and the headset for free nickel. The test of the antenna, which was plastic coated with metallic paint, was negative. The test of the headset was strongly positive for free nickel. The patient began using a cellphone that contained no nickel, and his facial dermatitis cleared. He decided to resume using his old cellphone to confirm that it had caused his dermatitis and the eruption recurred (Figure 1).

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Figure 1: Patches of eczematous dermatitis on patient's face (left) in areas that came into contact with the headset of his cellphone (right).

We performed spot tests for free nickel on 22 different popular models of cellphones from 8 manufacturers and a Bluetooth headset. We used a commercially available kit (Allertest Ni, Allerderm Laboratories, Phoenix, Arizona), in which we applied a drop of dimethylglyoxime and a drop of ammonium hydroxide solution to a cotton-tipped applicator and rubbed it on the part of the equipment being tested (Figure 2, left). A pink colour on the applicator indicates the presence of free nickel. We performed spot tests on the menu button, the headset, the area bordering the screen and any other metallic areas that could come into contact with the skin (Figure 2, right). The results of the nickel spot testing are summarized in Table 1.

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Figure 2: Spot tests for free nickel were performed by adding a dimethylglyoxime and ammonium hydroxide solution to a cotton-tipped applicator and then rubbing the applicator on areas of cellphones likely to have skin contact. A pink colour on the applicator tip indicates the presence of free nickel (left). In some models, the area around the screen and the menu button tested positive for free nickel (right).

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Table 1.

In the last few years, use of wireless devices for basic communication has risen significantly around the world. In December 2006 the Canadian Residential Telephone Service Survey reported that two-thirds of Canadian households had at least 1 cellphone and that 80% of Alberta households had cellphone service.2 In the same year, a news report in the United States indicated that 53% of American adolescents aged 12–17 owned cellphones, up from 39% in 2005 and 33% in 2002.3 Given the widespread use of cellphones, the presence of metal in the exterior casing of these phones and the high prevalence of nickel sensitization in the population, it is not surprising that cellphones can cause allergic contact dermatitis. Recently, facial contact dermatitis from exposure to hexavalent chromium plating4,5 and to nickel6 in cellphones has been reported.

Although cellphone batteries containing nickel have received much attention as an environmental concern, little has been written about the presence of nickel in cellphone cases. Nearly half of the phones we spot tested contained some free nickel. The menu buttons, decorative logos on the headsets and the metallic frames around the liquid crystal display (LCD) screens were the most common sites.

There appears to be a relation between cellphone models and nickel content. Cellphones intended for rugged use, such as the Motorola i series (i580 and i870), often have rubber coating and no surface nickel. Those with more fashionable designs often have metallic accents and are more likely to contain free nickel in their casings.

Cellphone use should be considered in the differential diagnosis of facial and ear contact dermatitis in individuals who are sensitive to nickel. Manufacturers and industrial designers should be aware of the potential for cellphones to cause allergic reactions related to nickel. Before purchasing cellphones, individuals sensitive to nickel should consider spot testing phones for free nickel. Nickel spot-test kits such as the one we used are readily available for consumer use. These tests are sensitive enough to detect the presence of free nickel at a level as low as 10 ppm — a threshold below which only individuals with the most pronounced sensitivity to nickel would experience a reaction. In addition, we recommend that cellphone retailers allow users with a medically documented allergy to metallic parts of their phones to exchange the equipment without penalty.

Footnotes

This article has been peer reviewed.
Competing interests: None declared.

REFERENCES
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REFERENCES

Pratt MD, Belsito DV, DeLeo VA, et al. North American Contact Dermatitis Group patch-test results, 2001–2002 study period. Dermatitis 2004;15:176-83.[Medline]
Residential Telephone Service Survey. Ottawa: Statistics Canada. Available: www.statcan.ca/Daily/English/070504/d070504a.htm. (accessed 2007 Oct 31).
Meyerson B. Schools crack down on cellphones. MSNBC; 2006 Available: www.msnbc.msn.com/id/14912068 (accessed 2007 Oct 31).
Seishima M, Oyama Z, Yamanura M. Cellular phone dermatitis. Arch Dermatol 2002;136:272-3.
Seishima M, Oyama Z, Oda M Cellular phone dermatitis with chromate allergy. Dermatology 2003;207:48-50.[CrossRef][Medline]
Wohrl S, Jandl T, Stingl G, et al. Mobile telephone as new source for nickel dermatitis. Contact Dermatitis 2007;56:113.[Medline]

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