Visual Diagnosis

Case: A 5-year-old girl presents to the ED with a rash around her belly button for 1 month. She complains of itching. Her parents deny any new exposures or anyone at home with a similar rash.

Diagnosis:

This rash is likely nickel or metal dermatitis.

Nickel or metal dermatitis is a rash caused by skin exposure to the back of a metal button on the patient’s pants or shorts. The buttons are generally made from nickel, and prolonged contact with the skin may cause a contact dermatitis to occur. Metal belt buckles may also cause a rash in a similar distribution. Nickel dermatitis may also be associated with earrings or other body piercings, jewelry, and watchbands.

Clinical Practice Pearls:

• While topical hydrocortisone cream may alleviate symptoms, definitive treatment is to avoid exposure to nickel contained in jewelry and on clothing.


• Dermatitis from pants or jeans may be prevented by placing a piece of fabric or tape over the back of the metal button or snap of the pants to avoid contact to skin.

Further Reading:

• Silverberg NB, Licht J, Friedler S, et al. Nickel contact hypersensitivity in children. Pediatr Dermatol. 2002;19(2):110-113.