Most acupuncture needles are stainless steel, an alloy of iron with chromium and nickel, both of which can cause allergic contact dermatitis, an itchy rash where an allergen touches the skin. Needles have also been made of silver and gold, are coated with silicone so they slide in more easily, and in some practices are left in the skin for days or for good. This page reports what studies have measured in the needles, the case reports of skin reactions to each material, the alternatives that have been tried, and how reviews of adverse events count these reactions. The reactions people usually notice after a treatment, from bruising to tiredness, are on After a treatment.

What are acupuncture needles made of?

Researchers at RMIT University in Melbourne examined single-use needles from two of the most widely used brands in 2014, one made in China and one in Japan, and analysed the surface of each with an electron microscope. By weight, the Chinese needles were about 18% chromium and 12% nickel, and the Japanese needles about 21% chromium and 10% nickel. Some needles carried small metallic lumps and loose pieces, mostly iron, chromium and nickel, and some of these were gone after the needles had been worked through a practice gel. The authors wrote that such pieces could be left in the tissue of a patient and could cause adverse events such as dermatitis, and called for better quality control.

A 2026 study of 120 stainless-steel needles used for dry needling with electrical current in 48 people, by a team at Miguel Hernández University in Spain, found chromium, nickel and silicon on every needle. The silicon on the surface fell after use, and the nickel stayed between about 6% and 8%. The authors wrote that the changes indicate material loss during the procedure and that tissue would have to be analysed to know whether this matters clinically.

Two studies looked at whether electrical stimulation corrodes the needle, which would free metal into the tissue. In a 2018 study in healthy volunteers, the RMIT group found no electrolytic corrosion on silicone-coated needles after 30 minutes of stimulation from a charge-balanced stimulator, and recommended that type of device. A 2019 study from the Korea Institute of Oriental Medicine found that needles of the steel grade STS316 resisted corrosion under electrical pulses better than the commoner STS304, and noted that electrical stimulation can expose the body to substances such as nickel ions.

The searches behind this page found no study that measured how much nickel an acupuncture needle releases into the skin.

Reactions to nickel and chromium

The case reports of allergy to steel needles are few and mostly old. Romaguera and Grimalt reported nickel dermatitis from acupuncture needles in 1979 and contact dermatitis from a permanent acupuncture needle in 1981, both as letters to the journal Contact Dermatitis.

In 1991 dermatologists at Osaka City University reported a 53-year-old man who developed a pigmented itchy rash, prurigo pigmentosa, on his back after three years of acupuncture. The rash stopped when he stopped treatment and came back when he resumed it. His needles were 18% chromium. A patch test, in which a suspected allergen is held against the skin to see whether a rash appears, was positive to potassium dichromate, a chromium salt, and the patch-test site flared up again when acupuncture resumed. The authors attributed the rash to contact allergy to the chromium in the needles.

In 2000 anaesthetists at Kinki University in Japan described a 65-year-old woman who came to them with painful red blistering dermatitis of the forehead and around one eye, six days after acupuncture for headache and stiff shoulders. A patch test with nickel sulfate was positive, and they diagnosed contact dermatitis from the acupuncture needle.

A 2021 report by allergists at Peking Union Medical College Hospital, Systemic contact dermatitis caused by acupuncture, called the needle a neglected route by which an allergen enters the body. Systemic contact dermatitis is a rash caused by a contact allergen after it has entered the body. The report has no published abstract and its text is behind a paywall, so this page does not report its findings.

Gold, silver and needles left in the skin

Gold needles and gold threads are left in the body on purpose in Korea and other Asian countries, and silver needles have been left in the skin in Japan. The reports about them describe several kinds of reaction:

  • Gold allergy, tested. A multicentre Korean study in 2001 patch-tested 255 people with eczema and 58 controls with a gold salt. 8 of the 255 reacted, and none of those reactions was clinically relevant. The authors had expected sources such as indwelling gold acupuncture needles to matter, and found they gave rise to few allergic reactions.
  • Pseudolymphoma. Dermatologists at Asan Medical Center in Seoul reported a patient in 2002 whose gold acupuncture produced a dense collection of immune cells in the skin, a T-cell-rich pseudolymphoma, which responded to steroid injected into the lesions.
  • Granuloma from gold thread. In 2022 dermatologists at Seoul St. Mary’s Hospital described a 50-year-old woman who had gold threads inserted into the skin of her face for cosmetic reasons and developed firm red plaques over them a month later. X-rays showed many threads, and a biopsy showed granulomatous inflammation, the body walling off a foreign material. Some threads were removed and the lesions treated with steroids; six months later they had improved slightly and remained. The authors note that gold is held to be inert, but that gold implants release gold ions in tissue.
  • Argyria. Silver left in the skin stains it blue-grey. A 2001 review of the Japanese case literature from 1987 to 1999 by Yamashita and colleagues found 124 cases of adverse events after acupuncture, including 10 of localised argyria and 26 of needles embedded on purpose. A 1985 report traced blue macules on a woman’s limbs to needles implanted for more than ten years; silver was a major component of the removed needles. A 1993 analysis of a similar case found silver deposits and a smaller amount of gold. Argyria has also followed treatment with needles that were removed: a 2020 report from Siriraj Hospital in Bangkok describes blue-grey spots that appeared about two months after some 20 sessions and cleared with laser treatment. Argyria is a deposit of metal rather than an allergy.

Needles left under the skin are the subject of Thread embedding.

Silicone coatings

Granulomas have formed around the silicone that coats many needles. In 2000 dermatologists at Kanazawa Medical University reported granulomas at the points where silicone-coated acupuncture needles, a venepuncture needle and a biopsy needle had entered one patient’s skin, and found silicon inside the immune cells by X-ray analysis. In 2020 eye surgeons at the Bascom Palmer Eye Institute in Miami described a 61-year-old woman with lumps around one eye and elsewhere on her face, which biopsy showed to be silicone granulomas. She had had facial acupuncture with single-use needles about 30 years before, and the lumps sat at the needling sites.

Ear seeds and press needles

Seeds, metal pellets and short press needles are taped to the skin and left for days, so the tape is also a source of reactions. A 2014 systematic review of adverse events of ear therapy by Tan and colleagues found 13 studies reporting 63 cases of itching, allergy or redness after ear acupressure. Most were put down to the adhesive tape; one study reported people allergic to magnetic pellets, whose rash went when the pellets were swapped for seeds. Seven people withdrew and five continued with a tape made for sensitive skin. The review advises practitioners to ask before treatment whether a person is allergic to steel needles, adhesive tape, magnetic pellets or other materials. Ear acupuncture and Press needles describe the methods.

What alternatives have been tested?

One trial has tested a metal-free alternative. In a 2025 pilot trial in Korea, 30 adults with mild to moderate eczema were randomised to steel press needles or patches of microneedles made of hyaluronic acid, a material that dissolves in the skin, worn for four hours twice a week for four weeks. The investigators recorded four adverse events of metal allergy, none severe, in the steel-needle group, and concluded that the dissolving needles may suit people with metal allergies. The trial was a pilot of 30 people, and its endpoints were eczema scores, not allergy.

The searches behind this page found no study of gold-plated or titanium acupuncture needles in people with metal allergy. The gold reports above concern solid gold left in the skin, not plated needles removed after treatment.

How adverse-event reviews count these reactions

The large reviews do not separate metal allergy from other skin reactions. A 2021 review of 21 prospective studies by Bäumler and colleagues sorted events into categories that include generalised skin reactions, which it estimated in 1 to 7 of every 1,000 patients over a course, together with several other categories, without naming a cause. A 2013 review of case reports by Xu and colleagues filed the silicone granuloma, the gold pseudolymphoma and the argyria from embedded needles under other complications. A 2016 series of 25 patients seen by dermatologists at Pusan National University for skin problems after acupuncture found infections most common and hypersensitivity reactions next, and 13 of the 25 had had bee venom acupuncture, an injection rather than a plain needle.

What the sources cannot tell you

Every reaction on this page comes from a case report or a small series, so none gives a rate, and none compares one needle metal with another. The needles in the older reports may differ from those sold now. AcuiQ’s entries record what a study prescribed, not the needles it used; What AcuiQ does not do sets out that limit.