Nickel is the most common allergen detected in patch-tested patients. Nickel allergy is highest among females and patients under the age of 18, affecting 35.8% of patients patch-tested in this demographic. Nickel allergic contact dermatitis is a T-cell-mediated immune reaction which most commonly presents as a skin rash in areas exposed to nickel; however, more serious reactions to nickel in medical devices and more widespread eruptions to dietary nickel can occur. In contrast to Europe, where regulations have resulted in a decreasing prevalence of nickel allergy, the incidence of nickel allergic contact dermatitis in North America is increasing. This article summarizes primary prevention strategies as well as management of patients already sensitized to nickel.