Metal Allergy and Body Piercing Part 1

Every single piercing I do, I bring up the question about sensitivity and being allergic to the chosen metal. It's an essential question because, with piercing, the goal is to make it as easy as possible for the body to accept the jewelry. Metal allergy is often unfairly blamed as the cause of a problem with piercings. This is because allergic reactions are similar to the reactions or signs of an infection or other health issue. So, in this installment of my piercing blo,g 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 many of the signs the body exhibits are similar to those of an allergic reaction. In fact, with an allergic reaction, the body's immune system is at the heart of the problem. For some reason, the body, either through exposure or plain old-fashioned 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 were a foreign pathogen that is harmful. In the same way, it would respond 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 reaction 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 is 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 overexposure to genetics. So, there is no real treatment to cure 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 healthcare industry are partly to blame for taking a two-pronged approach, suggesting that the patient may be experiencing a reaction to the metal and advising them to remove the jewelry, while still prescribing medication to combat the infection. Leaving one to wonder, was the jewelry the issue, or was it an infection?

The most significant 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 who 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 a few days to a couple of weeks, depending on the type of piercing and the individual's health. So, yes, even without the metal sensitivity, the piercing will display some signs of infection. However, it will not exhibit some of the more extreme reactions associated with an allergic reaction. For example, it's not uncommon for the piercing area to be discolored; however, if the area develops a rash, it's not normal. Nor are there 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. Additionally, it is not uncommon for a fresh piercing to itch; however, if the itching persists, it may be a sign of a reaction rather than a normal response.

Remember that allergic reactions happen early in the healing process. 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's also about the jewelry you choose, which I'll get into next.

Nickel Allergy:

The most common metal allergy is nickel, which is used in many types of jewelry, clothing, and other items that we like to be strong and shiny. There has been a push in Europe for some time to reduce the amount of nickel in commonly used products, 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 the degree of severity of the allergies or if the allergy is not as widespread 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 are my guess. Doctors who 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 an infection and an allergic reaction. The use of the term "Hypoallergenic," which was invented by the cosmetic industry in the 1950s to market makeup that was less likely to cause allergic reactions. This means that they didn't remove the cause of the allergic reaction; they only reduced it. So, if you are allergic to Nickel, then instead of it being 10% nickel, it's only 7% nickel. Oh, and in case you are wondering, there is no medical research backing the claim that any product labeled "Hypoallergenic" is less likely to cause an allergic reaction. 

Often, when I ask clients why they think they are allergic to nickel, they mention that they react to "cheap" post earrings when worn in their ears. Even jewelry labeled as Hypoallergenic is often plated with an undercoating of an alloy that contains nickel, copper, zinc, or other substandard materials. The plating does not entirely block the undercoating from leaking through, or the plating erodes due to the pressure the body puts on the jewelry during the healing process. The reaction to the undercoating and tarnish could cause a reaction that could be mistaken for a reaction to nickel. Additionally, since low-end jewelry often lacks clear documentation of the purity of the material or the material itself, it could be a reaction to a completely different metal or material altogether. So, it might not be nickel that they are reacting to at all.

I believe this all began with the widespread use of ear piercing devices and mass-produced ear piercing studs. Not only was the jewelry of a lower quality than that used in the past, but the number of those getting ear piercings increased significantly. Doctors and those using the devices were suddenly seeing a significant number of issues with ear piercings. It was easy to assume that the reaction was a result of the jewelry, and since Nickel is one of the most common metal allergies, it became the scapegoat and 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. The doctor's standard suggestion was to remove the jewelry and then prescribe antibiotics or some other medication just in case. Of course, if it were an allergic reaction, the problem would go away once the jewelry was removed, and if it were an infection, then the medication and the body's immune system would take care of it. 

Purity:

It's all about purity. The problem is that, unlike a bag of chips, 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, nickel is one of the most commonly used metals. It makes the gold more durable and increases the shine, and nickel is a cheaper option. Now, don't get me wrong, there is nickel-free gold, but a majority of commercial jewelry will have nickel in it. The lower the karat weight, the more nickel. So, regardless of what you have been led 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, which is not nickel-free, and which most reputable studios stock, may 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 be durable sufficient to withstand the pressure the body puts on the jewelry during healing. 

Since there is no way to inspect the jewelry and determine the purity of the alloy or its composition, the standard has been to require independent sources, other than the manufacturers, to test the alloy's purity. The most commonly used standards are American Society for Testing and Materials International (ASTM) and/or the International Organization for Standardization (ISO). These results are provided to the jewelry manufacturer 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 jewelry manufacturer or, on a retail level, the studio or retail outlet 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, chances are the alloy is closer to that used for bicycle spokes than Implant-Grade.

Finish & Durability:

One of the reasons that Surgical Stainless Steel and Titanium are the most commonly used metals 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 the healing process, the body will initially attempt to reject the jewelry. When that fails, it will try to erode, break down, and absorb the jewelry. This is why it is so essential 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 may be harmful. 

Finishing or polishing the jewelry is essential, regardless of the metal, and in a way, may be more critical. 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. Additionally, the finish will make the jewelry more durable and prevent pockets on the jewelry's surface where contaminants can collect. Thus reducing the risks of corrosion even further.

One of the most significant differences between high-end body jewelry and lower-priced jewelry is the finish. If the finish isn't up to industry standards, the jewelry is more likely to cause allergic reactions, infections, and 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 long been a more affordable alternative to solid 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, 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 the 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. Another issue is that as the plating is eroded, it can create pits and flaws in the finish, which may cause some problems. These issues include allergic reactions, as well as contaminants accumulating 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 somehow reduce the risks of an allergic reaction. Understand that in most cases, this is simply marketing with no facts to validate the claim. In fact, since often the purity of the overcoating of SSS is of a much lower grade, it will increase the risks more than that of high-grade implant-grade surgical stainless steel.

Conclusion:

• Often, nickel allergy has been cited with no clinical basis 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 problem.
• It is not uncommon for infections or other issues with the piercing to be misdiagnosed as a reaction to the parts of the jewelry's alloy.
• Allergic 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. Plated jewelry may be 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, wear only high-quality jewelry with a high polish, and if available, nickel-free.

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