Nickel Allergies in Permanent Makeup

Understanding Nickel Allergies

During a lifetime, 15-20% of individuals develop an allergy to nickel, making it one of the most common elements to cause allergic reaction, and the percentage is on the rise. Nickel allergies are more common than allergies to all other metals combined. Typically, women are more affected than men, with close to 36% of women in North America affected by the age of 18. This makes nickel allergies particularly relevant to microblading and permanent makeup.

When a known nickel allergy is brought up during a client query or consultation, there are often questions surrounding the safety of microblading or permanent makeup. Unknowing or uninformed artists might suggest a “patch test” to determine whether or not a reaction will occur. Unfortunately, the symptoms of nickel allergy do not commonly appear until at least 24-72 hours (or even up to many years) after exposure. This extended time between exposure and reaction may result in a false negative patch test, and exposure to a potentially serious allergen during an otherwise minor cosmetic or paramedical tattoo procedure.

Nickel Allergy Presentation

Nickel allergies commonly present as Allergic Contact Dermatitis and, once an individual is sensitized, tend to be a lifelong condition. Symptoms include severely itchy, inflamed skin; thick, raw or scaly skin; discoloured skin; and blisters. Severe allergies may also cause inflammation of the nasal passages as well as asthma attacks and other systemic symptoms.

In addition to diagnosed nickel allergies, clients with a history of Irritant Contact Dermatitis, which occurs with repeated exposure to mild irritants such as a particular soap or continued moisture, may be predisposed to develop Allergic Contact Dermatitis to other substances, including nickel.

The Source of Nickel in Permanent Makeup

Until recently, the source of allergic reactions in permanent makeup was thought to be nickel-contaminated iron oxides, though allergies were frequently reported in tattoos containing bright, organic colours. Investigation confirmed both organic and inorganic pigments to be present in the skin of the affected regions as well as in the lymph nodes of affected individuals.

Recent and further investigation into why particular colours seem to cause more sensitivity than others uncovered two unexpected factors:

1. Reactive tattoo sites contained titanium dioxide (white)
2. Reactive tattoo sites and lymph nodes of affected individuals contained microscopic needle fragments, detected via scanning electron microscope.

The presence of nickel in the skin and lymph nodes and subsequent allergic reactions were not from contaminated pigment at all, but from nickel-containing fragments of the tattoo needles!

This was a surprise because, although stainless steel tattoo needles contain roughly 6-10% nickel depending on grade, the specific reason it is used in the manufacturing of tattoo needles and medical instruments is for its resistance to erosion. But it has now been unequivocally proven that resistance is compromised in the presence of titanium dioxide.

At 200-350 nanometers, titanium dioxide is the largest, hardest and densest pigment particle used in tattooing and permanent makeup and it is extremely abrasive. The mechanical grinding of titanium dioxide against tattoo needles results in the erosion of the needles. Fragments of nickel-containing stainless steel from 50 nanometers to 2 micrometers are left within the skin and transported through the lymphatic ducts to the lymph nodes causing both localized and systemic allergic reactions in nickel-sensitized individuals. Smaller pigment particles, such as other organics and inorganics do not cause this same erosion.

How do we Keep Clients Safe?

1. Avoid pigments containing titanium dioxide whenever possible.
2. Screen for nickel allergy or irritant contact dermatitis on your intake form.
3. Do not use titanium dioxide on anyone with a nickel allergy or irritant contact dermatitis.
4. Ensure that clients with known nickel allergies understand the risks before consenting to the procedure and release you of liability should they have a reaction.