Abstract
A 7-year-old girl was seen because of a 2-month history of an expanding patch of pruritus and scaling just below her umbilicus (figure 1). The patient also complained of a generalized rash on her arms and legs that had been present for 10 days. Physical examination revealed a 5-cm scaling, excoriated, and lichenified papulovesicular rash on her abdomen inferior to her umbilicus. A fine papular rash was seen on her arms and legs. The patient often wore fly jeans in which the rivet behind the top metal button contacted her skin at the site of the abdominal rash. She had previously experienced a rash on both earlobes after wearing costume earrings. A presumptive diagnosis of allergic contact dermatitis from exposure to nickel was made. A patch test using nickel sulfate in petroleum elicited a strong papulovesicular reaction and confirmed the diagnosis. A dimethyl-glyoxime test of the rivet of her blue jeans was positive for nickel. The rivet and metal buttons were replaced with plastic buttons, and triamcinolone acetonide 0.1% cream was applied twice daily. The condition promptly resolved and has not recurred.
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