Demographic and clinical profile of allergic contact dermatitis patients who tested positive with metal allergy from a tertiary hospital: a 12 year retrospective study

Background: Allergic Contact Dermatitis (ACD), specifically to metals, remains a prevalent skin disease globally. Metal exposure continues to be a common cause of chronic and recurrent dermatitis in both occupational and non-occupational settings. This study aimed to determine the demographic and clinical profiles of patients with metal-induced ACD and to identify the most common metal allergens in a tertiary hospital setting.

Methods: A retrospective cross-sectional analysis was conducted among 421 patients who tested positive for metal allergy between 2012 and 2024. Patient records were reviewed for demographic characteristics, clinical presentation, anatomical distribution of lesions, reported allergen exposures, and patch test results. Data were analyzed descriptively to identify patterns of metal sensitization and exposure relevance.

Results: Nickel was the most prevalent metal allergen identified, followed by cobalt, chromium, and gold. Female patients and younger individuals were more frequently sensitized to nickel, which was often associated with non-occupational exposures such as jewelry and personal accessories. In contrast, cobalt and chromium allergies were more common among male patients, aligning with occupational exposures including cement, construction materials, and industrial products. Cutaneous lesions predominantly affected the hands, feet, and arms. More than half of the participants reported relevant exposure in relation to their positive metal allergen, supporting the clinical relevance of patch testing findings.

Conclusion: This study confirms the predominance of nickel allergy among patients with metal induced ACD and highlights recognizable patterns in demographic characteristics, clinical presentation, and exposure history. These findings may assist clinicians in the diagnosis and management of patients with suspected metal allergy. Patch testing remains a valuable diagnostic tool, particularly in patients with chronic, atypical, or overlapping dermatoses.