LAUSR

To the Editor: Nickel is the most common, yet still underdiagnosed, cause of allergic contact dermatitis in the United States.1 Because of its ubiquitous nature and presence inmany compoundmetals, the clinical presentation may vary from a localized dermatitis to systemic hypersensitivity and even symmetric drug-related intertriginous and flexural exanthema.2 Chromium, in addition, is also present in metal alloys to prevent corrosion.3 Surprisingly, however, there are little to no reports of metal-related allergic contact dermatitis in gym-goers. In the only study assessing metal allergen exposure when working out in the gym, Gumulka et al4 measured nickel concentrations with dimethylglyoxime in gymgoers after 1 hour of exercise on dimethylglyoxime-positive equipment and found relatively high doses of nickel on the skin. Metal-associated, particularly nickel-associated, dermatitis is therefore likely largely underreported in this population. We report the case of a 21-year-oldwomanwhopresented to our clinic with a 1-year history of recurrent rash on her upper chest and anterior thighs (Fig. 1). She reported that the rash is pruritic and noticed that the rash resolved when she was on vacation and not exercising at her gym. She wears gloves when she lifts weights and denies any similar eruption on her hands. We performed a standard 36-series T.R.U.E. test, which revealed +2 positivity to both nickel sulfate and potassium dichromate at 96 hours. On further questioning, the patient reported that she performs Olympic-style weight lifting as part of her CrossFit fitness regimen, which requires that she rest theweight-lifting bar onto her legs and subsequently onto her chest before raising the weights above her head to maintain final position. CrossFit is a branded fitness regimen based on performing various functional movements at a high intensity and has gained substantial popularity in the past several years.5 Many of the regimens include components of Olympic-style weight lifting, in addition to plyometrics and calisthenics. Typically, a standard Olympic weight-lifting bar is composed of either stainless steel or hard chrome because of its strength and ability to maintain ductility or its ability to resist bending despite repeated weightbearing. In the aforementioned study by Gumulka et al,4 the highest nickel content was present in weight-lifting bars and the quantities of nickel deposited on the skin are similar to those of locksmiths andmetallurgists after 1 hour ofwork, demonstrating that gym equipment is sufficiently apt in releasing nickel. Our patient responded quickly to topical corticosteroids and allergen avoidance via barrier protection. Given the popularity of this fitness regimen,we estimate the prevalence of this exposure to be largely underreported. In addition, this case highlights that even a relatively short contact with gym equipment is sufficient to elicit allergic contact dermatitis in sensitized individuals.