Metal Allergy and Body Piercing Part 2

In Part One, I covered the difference between Infections and allergic reactions, as well as some of the basic considerations that need to be taken into account when choosing the right metal for your piercing. In this installment, I plan to provide more information about the metal alloys themselves and what makes them the best choice. This all can be somewhat confusing on purpose. Since most states lack regulations and, at this point, no government agency regulates the jewelry industry, it is buyer beware, and individuals with metal allergies often need to educate themselves on 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 who feel they 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 from the jewelry that's 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 were 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 an alloy that is highly resistant to corrosion or tarnish.
3. The alloy should have as few impurities as possible.
4. The alloy should be a hard enough material that it can be highly polished to add another smooth layer of protection between the body and the alloy.
5. Additionally, it must be an alloy that can withstand sterilization in an autoclave. 

Body piercing has, over the years, concentrated on four primary metal alloys that have become standard: Surgical Stainless Steel, Niobium, Titanium, and Gold. Yes, other non-metal materials can be used, including wood, glass, bioplastics, and bone. However, due to the need to sterilize the jewelry and the stress it will undergo during healing, metal is usually the best and most commonly used material.

Titanium:

Titanium jewelry is by far the fastest-growing material in body piercing and the primary material we stock at the Axiom. This is in part due to the increasing concern about nickel, as the alloy is somewhat more durable than Niobium, especially when working with threaded jewelry. Unlike niobium, you can produce any jewelry style that you can create in Steel. Many studios and jewelry manufacturers have transitioned to using titanium exclusively. This has not only driven the price of jewelry and piercings up but also created a false faith that anything less than titanium is substandard. However, it is entirely possible to be allergic to Titanium or one of the two most commonly added elements, aluminium and vanadium. To say that it is 100% biocompatible is not entirely accurate, although the chances are extremely low.

Titanium is considered 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 alloy's 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 long been a misconception that gold is the safest option for those with nickel or other metal allergies. 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 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.  

For body piercing jewelry, it is recommended that the jewelry be made of 14kt or higher to minimize the risk of reactions to added elements such as 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 becomes, which reduces the durability of the finish. 

When buying gold jewelry, always do your research; some manufacturers are very secretive about what is in their gold alloy, or don't have a clue. Additionally, different colors typically indicate that additional parts of one of the elements have been added. For example, white gold can mean additional nickel has been added, which could affect 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 reacting. Just like with any jewelry, the finished product needs to be of high quality to minimize reactions and increase durability.

Surgical Stainless Steel:

By far, the most commonly used jewelry. Often referred to by the alloy's formula of 316L or 316LVM. The term Stainless Steel is more marketing than fact, but it does indicate that the material is more resistant to corrosion than other steel alloys. This is 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 of 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 steel, which increases the melting point and makes the metal more complex and resistant to erosion and damage. Thus making it more ideal for medical equipment and implants. Additionally, it has the lowest carbon content of all the SSS, making it resistant to magnetic waves and low in its ability to conduct current. 

Now, many of you are going to say, "Hey, I'm allergic to Nickel." Yes, if you want to be completely 100% safe, it would be best to move on to a completely nickel-free alloy. However, if the alloy is in fact 316L with the third-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 are 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 manufacturer comes into play. Additionally, nickel-free 316L SSS is available on the market.

Now, over the past few years, there has been an increase in plating SSS with Niobium, titanium, or gold. Since it is a much cheaper option than jewelry made entirely of that material, it is often a sign of lower-grade jewelry. The Plating will frequently erode from the jewelry in a very short time, and usually the finish on the SSS is substandard. So, if you have a metal sensitivity issue, plated SSS is not going to reduce the risks of a reaction and may increase the risks and make high-grade 316L Surgical Steel a better option. Often, the packaging will simply say oxidized Titanium and not refer it being plated. 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 variety of t-shirts and hair dye, the jewelry is pre-packaged, not sterile, and the price is $10 for 8 rings, because they are not made of pure titanium. Chances are that even the steel under the plating is not 316L. 

Niobium:

Niobium once represented a large portion of the body piercing jewelry on the market, but has been slowly replaced by Titanium. 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 pure niobium. It is, in fact, an element metal that is strong, resistant to corrosion, and easy to work with. If you have any fear of metal reaction, it would, in fact, be your best choice unless you are allergic to niobium. Another advantage is that metals like titanium can be anodized to create a variety of colors and color combinations. The only real disadvantage is that some of the darker shades, such as charcoal, can create a rough surface, making it less ideal for a fresh piercing.

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 an alloy that contains added elements. Thus, it is possible to react, though it's rare to react to titanium.
• Niobium is a pure element, and unless you are allergic to niobium, you will not react 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 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 that 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 everything it can to avoid this, and even with the best jewelry, placement, and aftercare, it may not accept the piercing. When a piercing acts up or a strange reaction occurs, the cause could be several things. It is always best to see your piercer and have them inspect it. 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 the best course of action is.