Cutaneous Metal Hypersensitivity Reaction
A 53-year-old lady underwent a left total knee arthroplasty. She developed a dermatitis over the left knee on postoperative day 5, which worsened over the next 2 weeks and spread to the trunk despite regular topical corticosteroids and oral antihistamines. Physical examination revealed an erythemato...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Karger Publishers
2022-03-01
|
| Series: | Case Reports in Dermatology |
| Subjects: | |
| Online Access: | https://www.karger.com/Article/FullText/523740 |
| _version_ | 1818048081332011008 |
|---|---|
| author | Sun Yang Ellie Choi Yau Hong Ng |
| author_facet | Sun Yang Ellie Choi Yau Hong Ng |
| author_sort | Sun Yang |
| collection | DOAJ |
| description | A 53-year-old lady underwent a left total knee arthroplasty. She developed a dermatitis over the left knee on postoperative day 5, which worsened over the next 2 weeks and spread to the trunk despite regular topical corticosteroids and oral antihistamines. Physical examination revealed an erythematous plaque over the left knee and urticated plaques over the neck. She was given a course of oral and topical corticosteroids with resolution. Subsequent patch testing showed a showing ++ reactions to gold and nickel, and + reactions to copper, palladium, rhodium, titanium, vanadium, zinc, and hydroquinone. Orthopedic implants contain metal alloys, which may include nickel, cobalt. Hypersensitivity to implants allergy may arise from the metal alloy or bone cement. Metal hypersensitivity reactions (MHR) can manifest as a local or systemic contact dermatitis weeks to months following exposure. The role of MHR in contributing to prosthesis failure is conflicting. In patients with no history of metal allergy, pre-implant patch testing is not routinely recommended as a positive patch test does not consistently predict in vivo metal-induced complication. MHR may be managed conservatively with good outcomes. However, in patients with MHR and implant failure, or in a preoperative patient with a proven and clinically relevant hypersensitivity, replacement of the implant, or implant with a titanium or oxidized zirconium alloy should be considered. |
| first_indexed | 2024-12-10T10:16:01Z |
| format | Article |
| id | doaj.art-93cc2b6aaee84be8b67ff8b2feb61833 |
| institution | Directory Open Access Journal |
| issn | 1662-6567 |
| language | English |
| last_indexed | 2024-12-10T10:16:01Z |
| publishDate | 2022-03-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Dermatology |
| spelling | doaj.art-93cc2b6aaee84be8b67ff8b2feb618332022-12-22T01:53:00ZengKarger PublishersCase Reports in Dermatology1662-65672022-03-01141616510.1159/000523740523740Cutaneous Metal Hypersensitivity ReactionSun Yang0https://orcid.org/0000-0001-8883-4349Ellie Choi1Yau Hong Ng2Division of Dermatology, Department of Medicine, National University Hospital, Singapore, SingaporeDivision of Dermatology, Department of Medicine, National University Hospital, Singapore, SingaporeDepartment of Orthopedics, National University Hospital, Singapore, SingaporeA 53-year-old lady underwent a left total knee arthroplasty. She developed a dermatitis over the left knee on postoperative day 5, which worsened over the next 2 weeks and spread to the trunk despite regular topical corticosteroids and oral antihistamines. Physical examination revealed an erythematous plaque over the left knee and urticated plaques over the neck. She was given a course of oral and topical corticosteroids with resolution. Subsequent patch testing showed a showing ++ reactions to gold and nickel, and + reactions to copper, palladium, rhodium, titanium, vanadium, zinc, and hydroquinone. Orthopedic implants contain metal alloys, which may include nickel, cobalt. Hypersensitivity to implants allergy may arise from the metal alloy or bone cement. Metal hypersensitivity reactions (MHR) can manifest as a local or systemic contact dermatitis weeks to months following exposure. The role of MHR in contributing to prosthesis failure is conflicting. In patients with no history of metal allergy, pre-implant patch testing is not routinely recommended as a positive patch test does not consistently predict in vivo metal-induced complication. MHR may be managed conservatively with good outcomes. However, in patients with MHR and implant failure, or in a preoperative patient with a proven and clinically relevant hypersensitivity, replacement of the implant, or implant with a titanium or oxidized zirconium alloy should be considered.https://www.karger.com/Article/FullText/523740metalsimplantimplant hypersensitivityallergic contact dermatitispatch test |
| spellingShingle | Sun Yang Ellie Choi Yau Hong Ng Cutaneous Metal Hypersensitivity Reaction Case Reports in Dermatology metals implant implant hypersensitivity allergic contact dermatitis patch test |
| title | Cutaneous Metal Hypersensitivity Reaction |
| title_full | Cutaneous Metal Hypersensitivity Reaction |
| title_fullStr | Cutaneous Metal Hypersensitivity Reaction |
| title_full_unstemmed | Cutaneous Metal Hypersensitivity Reaction |
| title_short | Cutaneous Metal Hypersensitivity Reaction |
| title_sort | cutaneous metal hypersensitivity reaction |
| topic | metals implant implant hypersensitivity allergic contact dermatitis patch test |
| url | https://www.karger.com/Article/FullText/523740 |
| work_keys_str_mv | AT sunyang cutaneousmetalhypersensitivityreaction AT elliechoi cutaneousmetalhypersensitivityreaction AT yauhongng cutaneousmetalhypersensitivityreaction |