Metal Allergy and Body Piercing Part 2

In part one, I covered the difference between Infections and allergic reactions and some of the more basic considerations that need to be taken when choosing the right metal for your piercing. In this installment I plan to go into a little more information about the metal alloys themselves and what makes them the best choice. This all can be rather confusing on purpose. Since most states do not have any regulations and at this point there is no government agency that regulates the jewelry industry, it is buyer be wear and often requires those with metal allergies to educate themselves to what will work best for them. I hope that this blog will help with that.

I think the most common response I hear from clients that feel they have have some form of metal sensitivity is that they can only wear the "real" stuff. At some point someone at a jewelry store or in the "know" has told them this. With ears it's often something completely different than the jewelry that is causing the problem.  When I ask what metals they consider "real" they say, gold and silver. Which as I pointed out in part one is often two of the worst options for a fresh piercing. So, if I was going to define what I would consider the "real" stuff, it would need to meet the following requirements:

1. Made 100% of the metal alloy. In other words not plated or filled.
2. Made of a alloy that is highly resistant to corrosion or tarnish. 
3. The alloy should have a few impurities as possible.
4. The alloy should be a hard enough material that it can be high polished to add another smooth layer of protection between the body and the alloy.
5. Also it needs to be alloy that will with stand being sterilized in an autoclave. 

Body piercing has over the years concentrated on Four main metal alloys that have become standard: Surgical Stainless Steel, Niobium, Titanium, and Gold. Yes, there are a number of other non-metal material that can be used including wood, glass, bio-plastics, bone, etc... but more often due to the need to sterilize the jewelry and the stress the jewelry will go through during healing, metal is often the best and most often used material.

Surgical Stainless Steel:

By far the most used and most common jewelry used. Often referred to by the alloys formula of 316L or 316LVM. The term Stainless Steel is more marketing than fact but does indicate that the material is more resistant to corrosion than other steel alloys. This is a achieved by the addition of at least 10.5% chromium which creates a passive film on the surface of chromium oxide. This film blocks oxygen diffusion and the spread of corrosion that would be caused by Iron Oxide aka rust. With 316L the level chromium is as high as 18% with at least 10% nickel which makes the steel extremely resistant to corrosion. With Implant grade SSS or Marine grade Stainless, it is a  molybdenum-alloyed. which increases the melting point and makes the metal much harder and more resistant to erosion and damage. Thus making it more ideal for medical equipment and implants. Also it has the lowest level of carbon of all the SSS making it resistant to magnetic waves and low at conducting current. 

Now, many of you are going to say, "Hey I'm allergic to Nickel." Yes, if you want to be complete 100% safe, it would be best of move on to a completely nickel free alloy. However, if the alloy is in fact 316L with the thrid party ASTM F-138 and the finish of the jewelry is mirror, the chances of you having contact with any of the nickel in the jewelry is extremely limited. The combination of the purity of the alloy, the chromium combined with molybdenum allows for a finish that is not only high polish but a strong barrier on the surface of the jewelry. This is where buying jewelry from a good manufacture comes into play. Also there is nickel free 316L SSS on the market.

Now other the past few years there has been an increase of plating SSS with Niobium, titanium or gold. Since it is a much cheaper option than jewelry made completely of that material it is often the sign of lower grade jewelry. The Plating will often erode from the jewelry in often a very short time and usually the finish on the SSS is substandard. So, if you have metal sensitivity issue, plated SSS is not gong to reduce the risks of a reaction and may in fact increase the risks and make high grade 316L Surgical Steel a better option. Often the packaging will simply say oxidized Titanium and makes no reference to it being plating. The only clue to it being plated is the store selling it or the extremely low price. For example, if you are in an alternative store with a bunch of t-shirts and hair dye, the jewelry is pre-packaged, not sterile and the price is $10 for 8 rings, causes are they are not pure titanium, in fact chances are that even the steel under the plating is not 316L. 

Niobium:

Niobium was once represented a large portion of the body piercing jewelry on the market but has been slowly replaced by Titanium. In fact, when I first started piercing in 1994, over 60% of the jewelry I sold was niobium made by the much missed Good Art Co. Now you would be hard pressed to find solid niobium jewelry in most studios. This was mainly because of the increased cost of Niobium. Unlike Steel, Gold or Titanium, the niobium used in body piercing jewelry is in fact pure niobium. It is in fact an elements metal that is strong, resistant to corrosion and easy to work with. In fact if you have any fear of metal reaction it would in fact be your best choice unless you are allergic to niobium. The other advantage is that the metal like titanium can be anodized to create a number of different colors and combinations. The only real disadvantage is that some of the darker colors like charcoal could create a rough surface and make it not ideal for a fresh piercing.

Titanium:

Titanium jewelry is by far the fastest growing material in body piercing. This is in part do to the increasing concern about nickel and that the alloy is some what more durable then Niobium especially when working with threaded jewelry. Unlike niobium you can produce any jewelry style that you can produce in Steel. Many studios and jewelry manufactures have completely moved to only use titanium. Which has not only driven the price of jewelry and piercings up but created a false faith that anything less than titanium is substandard. However, it is completely possible to be allergic to Titanium or one of two most commonly added elements aluminium and vanadium. So, to say that it is 100& biocompatible is not completely true, though the chances are extremely low.

Titanium is consider one of the most biocompatible alloys on the planet. Due in part to the protective oxide film that forms naturally on the surface of the alloy when it comes in contact with oxygen. This film increases the alloys durability, resists corrosion and in theory would also isolate the elements of the alloy from the body. The other advantage it has over Steel, Niobium and Gold is that it is lighter which could reduce stress during healing and when wearing large gauge jewelry. The other advantage is that like niobium it can be anodized into different colors and combinations. Though all Titanium grades are considered biocompatible, Grade 23 is considered best for Body Piercing Jewelry with the third party ASTM F-136.

Gold:

Time and time again, I've had someone walk into my studio and demand that they can only wear gold. There has always been this misconception that somehow gold was the safest option for those with nickel or other metal allergy. Often they are shocked when I state that in most cases there is a small amount of nickel in most gold jewelry. It is used to increase durability and shine. There is also a misunderstanding of what karat weight really means. Yes, the higher the karat weight the more gold is included in the alloy. However, there are 24 Karats or parts to all gold alloys. So, if it's 10kt(what most wedding rings are), then that means it is 10 parts gold and 14 parts something else.  

With body piercing jewelry, it is suggested that the jewelry be greater than 14kt to reduce risks of reactions to added elements like Silver, Copper, Nickel, Tin, Palladium, Zinc and Manganese. Since the jewelry will be under a great deal of stress during healing, I don't suggest piercing with gold at all or even after the piercing is healed wearing any jewelry with Karat weight above 18kt. The reason is that the more pure the gold the softer the alloy become which reduces the durability of the finish. 

When buying gold jewelry always do your research, some manufactures are very secretive about what is in their gold alloy or don't have a clue. Also different colors will usually mean that additional parts of one of the elements have been added. For example, white gold can mean additional nickel has been added which could effect how you react to it. Since colored gold has become a trend of late, here are the basic additives to more common gold colors:

• White Gold -  nickel, manganese or palladium
• Rose, Red or Pink Gold - Copper, Zinc, and/or Silver
• Spangold - aluminium, and copper
• Green Gold - cadmium, silver and copper
• Grey Gold - palladium or manganese.

So, it's safe to say that if you are sensitive to metals that gold may not be the best choice and colored gold only increases the chances of having a reaction. Just like with any jewelry the finished needs to be of a high quality to reduce reactions and also to increase durability.

Conclusion:

• The best options for those with sensitivity to metals are:
  1. Niobium
  2. Titanium
  3. 316L Implant Grade Stainless Surgical Steel
  4. 14kt to 18kt Gold
  5. 14kt to 18kt colored gold
  6. Titanium, gold or niobium plated SSS.
• If you are sensitive to nickel it is possible to wear 316L steel jewelry if it is nickel free or has a high mirror finish. 
• Titanium is not a pure element but a alloy that contains added elements. Thus it is possible to have a reaction though it's rare to titanium.
• Niobium is a pure element and unless you are allergic to niobium you will not have a reaction to it. 
• Karat is the number of 24 parts of a gold alloy that is in fact gold. Even a gold with a high karat weight can contain elements that you could have reactions to. 
• There is more nickel in most 14kt gold alloys than there is in 316L implant grade steel.
• Since gold isn't as durable as Steel, Niobium, or Titanium, it is not a good choice for healing a piercing. 

The truth with piercing is there is no sure bet which jewelry metal will be best for you. Like piercing in general the act of healing a piercing is getting your body to accept a foreign object. Your body will do every thing it can to avoid this and often even with the best jewelry, best placement and best aftercare, the body will not accept the piercing. When a piercing acts up or there is suddenly a strange reaction, the cause could be a number of things. It is always best to see your piercer and have them take a look. They have a great deal more experience resolving problems with piercings than you and often without seeing the piercing first hand it's hard to say what the problem is, what the cause is and what is the best course of action.