Q:

12/21/2012
I have a patient who has had blistering rashes under her wedding ring, which is platinum, during fall and spring only. She has a documented history of seasonal allergens during fall and spring, but her rash is only in the area of her wedding ring. I was going to refer her to dermatology for extensive metal patch testing...good idea or no? I have not encountered potential allergy to platinum...and not convinced it is this as the rash will disappear. Thank you!

A:

Thank you for your inquiry.

Wedding ring dermatitis is a “well-recognized entity,” but the literature about occlusion dermatitis under rings has been almost solely limited to dermatology journals. However, we have dealt with this issue once previously on our website. I have copied for you below the previous question and response to a similar question.

I have also copied below an abstract regarding dermatitis to platinum. As you can see, it is rare but has been reported.

Finally, the decision regarding whether you would like to pursue patch testing yourself versus sending the patient to a dermatologist is one based upon your own preference. However, you can obtain patch tests to platinum. Should you wish to do patch testing, metals for patch testing are available from certain suppliers. Listed for you below are three such suppliers:

Chemotechnique Diagnostics (Malmo, Sweden)

Hermal (Reinbek, Germany)

Brial Allergen (Greven, Germany)

In summary, I believe your patient has occlusion dermatitis ("wedding ring dermatitis"). It can be due to irritant or allergic contact dermatitis. Platinum is an unusual cause for contact dermatitis, but has been reported. One can obtain patch test materials if you wish to patch test yourself, or one can refer to a dermatologist.

Thank you again for your inquiry and we hope this response is helpful to you.

Occlusion dermatitis
Question posted to Ask the Expert website 6/6/2012:

45y/o female with a dermatitis only under wedding ring when she wears it for > 2-3 days. She wears other nickel earrings, belts without problems. Rings that are not "solid" cause no type of rash. Her history isn't consistent with metal allergy as it is an occlusion dermatitis--have you heard of this? How common is this and what can be done besides topical steroids? Thank-you.

Answer:
Thank you for your inquiry.

Occlusion dermatitis is a condition which is, to my knowledge, not dealt with in the Allergy-Immunology literature, but has been reviewed in-depth in the Dermatology literature. It is quite common. The article by Zhai and Maibach (referenced below) is a brief but comprehensive review of occlusion dermatitis. The entire article is available free of charge.

The condition you are describing is commonly referred to as "wedding ring rash." If it is not due to contact dermatitis, it is usually related to an irritation from the buildup of soap, moisture, and debris underneath the ring.

Unfortunately I know of no specific therapy other than trying to keep the area dry, and perhaps applying topical corticosteroids as you have mentioned.

Finally, I would agree that from what you say, it is likely that the condition is occlusion dermatitis, but I believe to make this diagnosis for sure, you would need to rule out contact dermatitis by patch testing.

There is a very nice brief discussion of "wedding ring rash" on the website of "Medicinenet.com".

Thank you again for your inquiry and we hope this response is helpful to you.

Reference:
Skin occlusion and irritant and allergic contact dermatitis: an overview. Hongbo Zhai, Howard I. Maibach. Contact Dermatitis, April, 2001; Volume 44, Issue 4, pages 201–206.

Dermatitis. 2008 May-Jun;19(3):146-7.
Positive patch-test reactions to platinum are rare.
Fowler JF Jr, Perryman JH, Quinlan B.
Source
Division of Dermatology, University of Louisville, Louisville, KY, USA.
Abstract
Background: Although contact allergy to some metals is common, patch testing for allergy to platinum is rarely performed.
Objective: To determine the prevalence of positive patch-test reactions to platinum in an unselected consecutive group of patients presenting for diagnostic patch testing.
Methods: Unselected patients who presented with a possible diagnosis of contact dermatitis were tested with a series of allergens, including ammonium tetrachloroplatinate 0.25% aqueous.
Results: Of 446 patients tested, only 2 females showed positive reactions to platinum; one had no other positive reactions, and the other had reactions to other metals.
Conclusions: Positive patch-test reactions to platinum are rare. However, platinum jewelry may occasionally provoke allergic contact dermatitis.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology