A biopsy was done of the nodule and pathology showed a skin reaction with epithelioid histiocytes surrounded by a dense infiltrate of lymphocytes.
Allergic patch testing was done and it showed a positive reaction to nickel and a strong reaction to palladium. The skin reaction to palladium (done on her back) persisted for months and was not relieved with strong corticosteroid cream.
The reaction on her skin finally disappeared after injecting it with corticosteroids. The ear lesion required surgical excision.
Allergies to metals are common and any piercing that does not heal may be an allergic reaction to one of the metals or alloys used in the metal. Similar cases have occurred with nickel, gold and platinum from ear piercings.
From Medscape and the American Contact Dermatitis Society, 2008