Background Body piercing provides a unique route of metal exposure. Objective The aim of this study was to update previous analyses using the North American Contact Dermatitis Group data comparing pierced and unpierced individuals. Methods This was a retrospective cross-sectional analysis of 17,912 patients patch tested by the North American Contact Dermatitis Group from 2007 to 2014 for demographics, positive reactions to metals (nickel, cobalt, chromium), and detailed analysis of nickel reactions by age, sex, and source of exposure. Results Piercing was significantly associated with female sex, being older than 18 years, and atopy (P
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