Metal hypersensitivity reactions to implants: opinions and practices of patch testing dermatologists

Abstract

Background: Cutaneous metal hypersensitivity reactions (MHR) are common but rare with implanted devices.

Objectives: This study aimed to characterize the opinions of dermatologists who are actively evaluating/advising patients with MHR.

Methods: A questionnaire was distributed to all individuals who attended the European Society of Contact Dermatitis (ESCD) 2012 and the American Contact Dermatitis Society 2013 meetings.

Results: A total of 119 individuals responded with a participation rates of 10% (ESCD) and 32% (American Contact Dermatitis Society). Ninety-six percent of the respondents evaluate MHR and 91% were attending physicians. Orthopedic and dental devices were common problems compared with cardiovascular devices. Patch testing is the top choice for evaluating MHR. Lymphocyte transformation and intradermal tests are rarely used. Eighty-two percent of the respondents evaluate plastic/glue components in symptomatic patients postimplant. Most dermatologists use a tray specifically for joint allergy or a history-based custom array of allergens. Those patients with a strong clinical history of metal allergy should be evaluated before metal implantation (54%), whereas others forgo evaluation and recommend a titanium implant based on history alone (38%). Diagnostic criteria for postimplant reactions were evaluated. Eight percent of the respondents felt that no evaluation was necessary, with ESCD respondents being significantly more likely to not recommend evaluation (P = 0.001).

Conclusions: Metal hypersensitivity reactions consultation requests are common for preimplant and postimplant issues. Patch testing is currently the best test for MHR.