Metal Allergy and Body Piercing Part 1

Every single piercing I do the I bring up the question about sensitivity and being allergic to the chosen metal. It's an important question because with piercing, the goal is to make it as easy as we can for the body to accept the jewelry. Metal allergy is often unfairly blamed as cause of a problem piercing. This is because allergic reactions are a lot like those reaction or signs of an infection or other problem. So, in this installment of my piercing blog I thought I'd take the time to explain just what an allergic reaction is and some of the basics about the body piercing jewelry used. 

Allergic Reactions vs Infection:

Often an infection or other problem is blamed on a reaction to the metal because a lot of the signs the body gives are very much like those of an allergic reaction. In fact, with an allergic reaction it is the body's immune system that is at the heart of the problem. For some reason the body either through exposure or plain old fashion genetics decides that the metal is harmful to the body. Instead of treating the material as simply a foreign object, it reacts in the same way it would if the metal was a foreign pathogen that is harmful. In the same way it would react to bacteria, a virus or toxic material, going on the defensive to repeal and destroy the invader.So, the reaction to an infection and an allergic reactions to metal will produce some of the same signs including Heat/fever, inflammation/swelling, discharge, pain/throbbing pain, and discoloration of the tissue around the location.

The immune system like an airport security guard, it has a watch list and once a material is on that list, it will always react the same way every time it is exposed to the material. There is no clear understanding of what causes allergic reactions. The theories range from over exposure to genetics. So, there is no real treatment to cure one of a metal allergy. However, because as humans we tend to be prone to Self-diagnosis, often people think that they are allergic to Nickel or some other metal but have never been clinically tested for the allergy. Those in the health industry are partly to blame for taking a two prone attack saying that they ;maybe having a reaction to the metal and to remove the jewelry while still prescribing medication to fight off infection. Leaving one to wonder, was the jewelry the issue or was it an infection.

The biggest difference between infections and reactions is that reactions to the metal will usually begin within the first couple of days. The problem is that even with someone that doesn't have an allergy to the metal, the body is going to try to get you to take the jewelry out. The acceptance phase of a piercing can last from just a few days to a couple of weeks depending on the piercing, and the person's health. So yes, even without the sensitivity to metal the piecing will display some signs of infection. However, it will not have some of the more extreme reactions of an allergic reaction. For example, it is not uncommon for the piercing area to be discolored but if the area develops a rash, then it's not normal. Nor is raised bumps in the area, blistering or dried skin that resembles a burn. A normal acceptance period may involve some light drainage but not a blister with drainage. Also it is not uncommon for a fresh piercing to itch but if it is obsessive then it might be a reaction and not something normal.

Remember that allergic reactions happen early in the healing. If you have reactions, let's say 4 weeks after the piercing was done, then chances are your piercing is infected or has some other issue. Now if the piercing is healed and you change jewelry and suddenly start having some of these reactions, then it may very well be an allergic reaction. It's all about timing but it is also all about the jewelry you choose which I will get into next.

Nickel Allergy:

The most common of all metal allergies is nickel and nickel is used in a lot of jewelry, clothing and just about anything we like to be strong and shinny. There has been a push in Europe for some time to reduce the amount of nickel in commonly used product but the longer I pierce the more I begin to wonder if it is really that common. When you consider that just about every belt buckle, wrist watch back, eyeglass frames or rivet on a pair of jeans contains nickel it makes one wonder if it is degrees of severity of the allergies or if the allergy is not as wide spread as believed. So, if you haven't had a problem with any of those items or wearing 10kt gold jewelry, the chances are you are not allergic to nickel in the first place.

So, why do so many think that they are? Laziness, miscommunication and misinformation is my guess. Doctors that mistakenly assume that an infected piercing is an allergic reaction. Store clerks with no knowledge of the products they are selling, let alone the difference between a  infection and an allergic reaction. The use of term Hypoallergenic which was invented by the cosmetic industry in the 1950s to market make-up that was less likely to cause allergic reaction. Which means that they didn't remove the cause of the allergic reaction only reduced it. So, if you are allergic to Nickel then instead of it being 10% nickel it's only 7% nickel. Oh and case you are wondering there is no medical research backing any product that is labeled "Hypoallergenic" is less likely to cause an allergic reaction. 

Often when I ask clients why they think they are allergic to nickel, they bring up that they have a reaction to "cheap" post jewelry when worn in their ears. Even the jewelry that is labeled as Hypoallergenic is often plated with an undercoating of an alloy that contains some nickel, copper, zinc or other substandard material. The plating does not completely block the undercoating from leaking through or the plating erodes from the pressure the body puts the jewelry through during the healing. The reaction to the undercoating and tarnish could cause reaction that could be mistaken for a reaction to nickel. Also, since often with low end jewelry there is no clear documentation to the purity of the material or the material at all, it could be a reaction to a completely different metal or material all together. So, it might not be nickel that they are having a reaction to at all.

I think this all started with the wide scale use of ear piercing devices and mass produced ear piercing studs. Not only was the jewelry of a lower quality than was used in the past but the number of those getting ear piercings increased greatly. Doctors and those using the devices were suddenly seeing a great number of issues with ear piercings. It was easy to assume that it must be a reaction to the jewelry and since Nickel is one of the most common metal allergies, then nickel became the scapegoat and then the standard cause of the problem. However, the unsanitary way in which the piercings were done, the lack of knowledge of placement and the one size fits all approach to jewelry may have been more to blame. Doctor's standard suggestion was to remove the jewelry and then prescribe antibiotics or some other medication just in case. Of course if it was an allergic reaction the problem would go away once the jewelry was removed and if it was an infection than the medication and the body's immune system took care of it. 

Purity:

It's all about purity. The problem is that unlike a bag of chips, the Jewelry's packaging rarely lists the metals in the alloy or the percentage of the metal. The exception is precious metals like gold and it's why often when someone has shown a sensitivity to metals, it has been suggested that they only wear precious metals like gold.

The Karat weight is a clearly defined way of expressing the purity of the metal. However, even the purest of gold as in 24kt is only 99.95% gold, the rest is often more common metals added to increase the shine and durability of the metal. Often one of the most commonly used metals is nickel. It makes the gold more durable and increases the shine and it nickel is a cheaper option. Now don't get me wrong there is gold that is nickel free but a majority of commercial jewelry will have nickel in it. The lower the karat weight the more the nickel. So, regardless of what you have been lead to believe about nickel, if you are wearing a 10kt wedding ring and other gold jewelry, chances are you are not allergic to nickel.  Oh and even the Implant Grade Surgical Steel jewelry that is not nickel free most better studios stock, will not be an issue for you.

All body piercing jewelry is made from alloys to be able to produce jewelry that is as body friendly as possible but still durable enough to be polished, be resistant to corrosion and durable to with stand the pressure the body puts on the jewelry during healing. 

Since there is no way to look at the jewelry and know how pure the alloy is or what is in the alloy, the standard has been to require independent sources other than the manufactures to test the purity of the alloy. The most commonly used stands are American Society for Testing and Materials International (ASTM) and/or the International Organization for Standardization (ISO). These results  are provided to the jewelry manufacture from the mill that produced the raw material in the form of Mill Certificates.

Now there is no way of knowing on a retail or even a wholesale level if any of the jewelry matches those Mill Certificates at all. So, it often comes down to the reputation of the manufacture of the jewelry or on a retail level the studio or retail outlet that is selling it. Though it is safe to say that a majority of the jewelry in retail outlets, clothing stores, department stores, and jewelry shops located in malls is not compliant with ASTM or ISO standards. The issue is that there is no way of knowing the purity of the alloy used to make this jewelry. So, if you bought four "Surgical Stainless Steel" Rings from the alternative shop at the mall for $20, chance are the alloy is closer to that used for bicycle spokes than Implant Grade.

Finish & Durability:

The one of the reasons that Surgical Stainless Steel and Titanium are the most commonly used metal in Body Piercing and the medical industry is their durability and resistance to corrosion. This is especially important in a piece of jewelry that is going to be subjected to the stress of healing a piercing. During healing the body will first attempt to reject the jewelry. When that fails it will attempt to erode, breakdown and absorb the jewelry. This is why it is so important that the jewelry is made of a solid alloy that is resistant to corrosion. In part to make the body accept the jewelry but also to reduce exposure to parts of the alloy that maybe harmful. For example, the "L" in 316L Surgical Stainless Steel represents Lead. That's right all SSS jewelry contains a small amount of lead.

Finish or polish on the jewelry is important regardless of the metal and in a way maybe more important. Even if you have a mild allergy to one of the parts of the alloy, the finish will help as a barrier between the jewelry and your body. Also the finish will make the jewelry more durable and avoid pockets on the jewelry's surface for containments to collect. Thus reducing the risks of corrosion even further.

One of the greatest differences between high end body jewelry and cheaper jewelry is the finish. If the finish isn't up to industry's standards, the jewelry is more likely to cause allergic reactions, infections and cause damage to the piercing during jewelry changes. Plus let's face it, high polish jewelry just looks better and will not dull over time.

Plated Jewelry:

Plated jewelry has always been a cheaper substitute to sold alloy jewelry. The biggest problem as I mentioned earlier, is that the plating barrier will often expose the body to the alloy beneath it and will chip away over time. Thus if you are allergic to any part of the alloy, chances are you will have an allergic reaction even with plated jewelry.

Over the last decade or so, there has been an increasing amount of Titanium and gold plated Surgical Stainless Steel that has flooded the market. Often the Titanium plated jewelry is sold marked as Titanium with no mention of the overcoating at all. The biggest reason is that they can produce anodized jewelry in a large variety of colors without the cost of using pure Titanium or Niobium.

Even with pure anodized jewelry the oxidized layer of cover can erode which is harmless. However with plated Surgical Stainless Steel, the body will be exposed to often a lower and less pure alloy that might not be as body friendly. The other issue is that as the plating is eroded it can create pits and flaws in the finish that may cause some issues. This issues include allergic reactions but also contaminants collecting in the pits, corrosion of the jewelry and damage to the piercing itself. So, once the plating erodes it is advisable to replace the jewelry.

The other problem is that often the plated jewelry is sold under the impression that the plating will some how reduce the risks of an allergic reaction. Understand that in most cases this just simply is marketing with no facts to validate the claim. In fact, since often the purity of the overcoating of SSS is of a much less grade and will in fact increase the risks more than that of high grade implant grade surgical stainless steel.

Conclusion:

• Often nickel allergy has been sighted with no clinical bases to be the cause of your issues, when in fact it could have been the purity, finish and over quality of the metal alloy itself that is causing the issue.
• It is not uncommon that infections or other issues with the piercing to be misdiagnosed as a reaction to the parts of the jewelry's alloy. 
• Allegoric reactions to metal happen quickly after the jewelry enters the body. Usually within the first 48 hours. 
• Plated jewelry is not a better option if you have metal sensitivities. In fact, plated jewelry maybe a worse option due to the low quality undercoating that is often used.
• You may not be allergic to nickel at all and really the only way to know for sure is to be medically tested for the allergy. However, to reduce the risks only wear jewelry that is of high quality, with a high polish and if available nickel free.

In Part 2, I will go more into the difference in the alloys and the advantages and disadvantages.