In a recent issue of the journal Pediatrics, two dermatologists reported the first case of iPad associated contact dermatitis.

This is not the first time a wearable or mobile device has been implicated in causing allergic contact dermatitis. Earlier this year, the Consumer Product Safety Commission ordered a recall of the Fitbit Force over concerns of skin rashes and irritation. The recall was in response to a storm of negative coverage over the Force’s skin irritation (with 9,900 reports according to Fitbit) and blistering (250 reports). An analysis posted earlier this year here on iMedicalApps illustrated the surge in complaints on the Fitbit community forums over the Fitbit Force, linking them to possible nickel exposure via the altimeter port or charging port on the Force.

The Fitbit Force joined products as diverse as razors and the XBox as being implicated in allergic contact dermatitis, most commonly from nickel. Allergic contact dermatitis causes an acute dermatitis with erythema, vesiculation and oozing caused by sensitization to an environmental antigen than penetrates the dermis. The most common cause of allergic contact dermatitis in children are plants (poision ivy or oak) with nickel being the second most common (Weston, et al, 52-55). The North American Contact Dermatitis Group (NACDG) has illustrated a steady rise in nickel contact dermatitis confirmed by patch testing, especially among children and adolescents.

Over the past few years, the ubiquitous rise in cell phone use has led to a corresponding rise in nickel contact dermatiits, leading to the diagnosis of “cellular phone dermatitis” or “mobile phone dermatitis” in children and adolescents1. For its role in contact dermatitis, nickel received the dubious honor of “Contact Allergen of the Year” in 2008. Although the lesions of allergic contact dermatitis are usually limited to the areas of direct contact, children with eczema can have generalized dermatitis flares in response to exposure, which makes isolating an allergic cause more challenging.

Although the MacBook Pro (Jensen, et al, 2012) and iPhone 5 (Jensen, et al, 2013) have been implicated in either allergic contact dermatitis cases or testing positive for excessive amounts of nickel, the iPad has so far been spared cases of skin irritation that recalled the Fitbit Force2,3. However, Sharon Jacobs and Shehla Admani, dermatologists at Rady Children’s Hospital in San Diego, have reported the first published case of a child with allergic contact dermatitis from an iPad4.

An 11-year-old boy with a history of atopic dermatitis had been having generalized dermatitis for over 6 months that had not responded to triamcinolone, which had worked for his eczema in the past. He underwent patch testing that was positive for nickel exposure and his family had noted that he was extensively using his first-generation iPad, which he received before the onset of symptoms. The back panel of his iPad tested positive for nickel with dimethylglyoxime, the standard test for nickel-containment. The patient received a Smart Case for his iPad as part of a nickel-avoidance regimen and his dermatitis significantly improved5.

This case report, the first published case of the iPad causing nickel-dermatitis, is a reminder of the risks of metal-containing technology products, especially for children and adolescents with atopic dermatitis. The authors did not test future generations of the iPad or any generations of the iPad Air, so it is unclear if they contain nickel as well.

Regardless, parents of children with atopic dermatitis and/or nickel allergies should be aware of the possibility of nickel containing objects, and providers caring for children with generalized dermatitis should ask about technology exposures. Certainly wearables, such as the Fitbit Force or the long-rumored iWatch, will have even greater risks for nickel allergies given the duration of their skin contact. But as tablets, phablets, and smart phones become ever more ubiquitous, nickel-related allergic contact and generalized dermatitis will continue to become an increasing concern.