Korean J Dermatol.  2021 Nov;59(9):713-719.

The Assessment of the Effect and Patient Compliance of Nickel-Restricted Diets in Patients with Nickel Allergy

• Kim R
• Lee MY
• Byun JY
• Choi YW
• Choi HY

Abstract

Background
Nickel is one of the leading causes of allergic contact dermatitis. Positive patch tests for nickel suggest the possibility of persistent dermatitis from nickel-plated item usage and nickel-containing food ingestion. Previous studies have suggested the clinical improvement of dermatitis in such patients after a nickel-restricted diet.
Objective
This retrospective study aimed to assess the efficacy of nickel-restricted diets in nickel-sensitized patients and evaluate their adherence to nickel-restricted diets.
Methods
A review of the records of nickel-sensitized patients from June 1, 2018 to April 30, 2020 with positive patch tests for nickel was conducted. Patients were interviewed in May 2020 to assess the current status of dermatitis and self-reported adherence.
Results
A total of 245 patients were identified, and 100 patients were contacted. The degree of nickel sensitivity between patients with localized skin lesions (n=44) and generalized skin lesions (n=56) did not show difference. Twenty-four of 29 patients (82.8%) with good compliance showed improvement, while only 32 of 71 patients (45.1%) with poor compliance showed improvement. The percentage of improved patients in the group with good compliance and that in the group with poor compliance showed a statistically significant difference (p=0.00086). Of the patients with good compliance, those with localized skin lesions showed statistically significant improvement (p=0.0074).
Conclusion
To improve patient compliance, revised, simplified, and interventional guidelines for nickel-restricted diet should be implemented along with dermatologists’ encouragement and reassurance of a diet modification.

Keyword

Allergic contact dermatitis; Compliance; Nickel; Patient compliance