What recommendations do you make for patients with lower abdomen eczema from nickel in their belt buckle?

This is a common clinical scenario in the United States as there are no legal limits on the use of nickel in objects in contact with the skin. Belt buckle dermatitis on the lower abdomen is almost pathognomonic for nickel allergic contact dermatitis (ACD). There are several consumer test kits to detect the presence of nickel. These kits use dimethylglyoxime. The treatment for ACD is avoidance. Once the dermatitis occurs, the use of medium to potent topical steroids is indicated.

Treatment options include replacement of the belt buckle with a non-metal buckle such as plastic. Another option is to replace it with a brass or silver buckle. If you want to keep the buckle you could coat it with Nickel Guard ® which is a clear lacquer. Another al...