True allergy type reactions to metals are extremely rare, but they do occur. In this case, the reaction developed while the subject was wearing 14 carat gold. The worst offenders are low carat golds (below 18) and costume jewelry, including so-called 'surgical steel' and 'hypoallergenic' varieties. When a reaction occurs, it presents as a contact dermatitis, spreading from the site of contact. The lesions are raised red welts which are constantly weeping serum and impossible to dry. The subject will probably feel an itching or burning sensation associated with the lesions.

The first suspected cause of any contact dermatitis is the cleaning regimen. Most occurances respond immediately to a massive change in aftercare products used, accompanied by a single application of hydrocortizone directly to the lesions. If the jewelry is suspect, it should also be changed to type 316L (the metal used for all high-grade body jewelry).

Removal of the offending jewelry is typically only done as a last resort.