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Sadrolvaezin A, Pezhman A, Zare I, Nasab SZ, Chamani S, Naghizadeh A, Mostafavi E. Systemic allergic contact dermatitis to palladium, platinum, and titanium: mechanisms, clinical manifestations, prevalence, and therapeutic approaches. MedComm (Beijing) 2023; 4:e386. [PMID: 37873514 PMCID: PMC10590457 DOI: 10.1002/mco2.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 10/25/2023] Open
Abstract
Contact dermatitis (CD) is an inflammatory skin disease of eczema that is elicited by chemicals or metal ions that have toxic effects without eliciting a T-cell response (contact elicitation) or by small reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens). The clinical condition is characterized by localized skin rash, pruritus, redness, swelling, and lesions, which are mainly detected by patch tests and lymphocyte stimulation. Heavy metals such as palladium (Pd), platinum (Pt), and titanium (Ti) are ubiquitous in our environment. These heavy metals have shown CD effects as allergic agents. Immunological responses result from the interaction of cytokines and T cells. Occupational metal CD accounts for most cases of work-related cutaneous disorders. In this systematic review, the allergic effects of heavy metals, including Pd, Pt, and Ti, and the mechanisms, clinical manifestations, prevalence, and therapeutic approaches are discussed in detail. Furthermore, the therapeutic approaches introduced to treat CD, including corticosteroids, topical calcineurin inhibitors, systemic immunosuppressive agents, phototherapy, and antihistamines, can be effective in the treatment of these diseases in the future. Ultimately, the insights identified could lead to improved therapeutic and diagnostic pathways.
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Affiliation(s)
- Ali Sadrolvaezin
- Medical Toxicology and Drug Abuse Research CenterBirjand University of Medical SciencesBirjandIran
| | - Arezou Pezhman
- School of MedicineZahedan Azad University of Medical SciencesZahedanIran
| | - Iman Zare
- Research and Development DepartmentSina Medical Biochemistry Technologies Co. Ltd.ShirazIran
| | - Shima Zahed Nasab
- Department of Life Science EngineeringFaculty of New Sciences and TechnologiesUniversity of TehranTehranIran
| | - Sajad Chamani
- Medical Toxicology and Drug Abuse Research CenterBirjand University of Medical SciencesBirjandIran
| | - Ali Naghizadeh
- Medical Toxicology and Drug Abuse Research CenterBirjand University of Medical SciencesBirjandIran
| | - Ebrahim Mostafavi
- Stanford Cardiovascular InstituteStanford University School of MedicineStanfordCaliforniaUSA
- Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
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Cristofaro C, Pinsker EB, Halai F, Wolfstadt J, Daniels TR, Halai M. Metal hypersensitivity in foot & ankle orthopaedic surgery: A systematic review. J Clin Orthop Trauma 2023; 44:102249. [PMID: 37841657 PMCID: PMC10568406 DOI: 10.1016/j.jcot.2023.102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/06/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Metal hypersensitivity affects 10-15% of individuals. Orthopaedic implants contain various metals and, therefore, metal hypersensitivity may impact patient outcomes. Purpose We report a systematic review of the literature on metal hypersensitivity in patients undergoing foot and ankle (F&A) surgery. Our goal is to provide an overview presenting symptoms, diagnostic methods, treatment, and clinical outcomes. Methods A comprehensive literature search of Ovid MEDLINE and EMBASE was performed from its inception (01-Jan 1966) to 23-Nov 2021. MeSH search terms on F&A were used including orthopaedic surgeries, metal types, and hypersensitivity. All full-text, English, experimental and observational studies reporting on metal hypersensitivity in the context of foot and/or ankle surgeries using metallic orthopaedic devices were included. Article screening, critical appraisal, and data extraction was performed by two reviewers. Disagreements were resolved by a third reviewer. Results Fifteen studies were identified, reporting on 45 patients (18 male and 27 female). Median age was 58 years and mean follow-up was 20.8 months. 42 static and three arthroplasty implants were included. In total, 19 patients (42.2%) were diagnosed with metal hypersensitivity to a constituent of their implant, including two (4.4%) patients diagnosed without metal hypersensitivity testing. Twenty-six patients (57.8%) tested negative to their metal implant components. Of the 19 patients allergic to a constituent of their implant, 14 underwent hardware removal and improved. Four patients were asymptomatic and the last was symptomatic, but not revised. Of these, 23 patients retained their hardware (eight with skin reactions) and two symptomatic patients underwent hardware removal. Conclusion Metal hypersensitivity in the context of F&A surgery is not widely reported. It should be a differential diagnosis in patients who present with hypersensitivity-type symptoms once infection and mechanical failure are ruled out. This data informs a comprehensive algorithm for identifying and treating metal hypersensitivity in F&A patients. Level of evidence Level IV.
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Affiliation(s)
| | - Ellie B. Pinsker
- Department of Surgery, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fatima Halai
- Family Doctor. Albany Medical Clinic, Toronto, Ontario, Canada
| | - Jesse Wolfstadt
- Department of Surgery, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Surgery, Division of Orthopaedic Surgery, Sinai Health, Toronto, Ontario, Canada
| | - Timothy R. Daniels
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mansur Halai
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
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Arora P, Magner ET, Bigliardi PL. Honey flower dermatitis: Contact allergy to ellagic acid in Melianthuscomosus. Food Chem Toxicol 2023; 179:113956. [PMID: 37482193 DOI: 10.1016/j.fct.2023.113956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/11/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023]
Abstract
A case study is reported whereby a patient with no prior allergies developed a strong and spreading delayed-type hypersensitivity reaction to Melianthus plants, nectar and synthetic pigment derived from it after frequent handling of these substances. The lesions improved after treatment with topical steroids and allergen avoidance within 1-2 weeks. Subsequent patch testing with the plants, nectar and synthetic ingredients identified ellagic acid (EA) as the sensitizing agent. This is the first proven case of allergic contact dermatitis to EA, a phenolic substance present in numerous plants, fruits, and nuts regularly consumed by humans. Melianthus use is growing worldwide as an ornamental plant. Moreover, it is used in traditional South African medicine for its anti-inflammatory effects. In recent years, these extracts and EA have been added to natural, plant-based topical formulations for the treatment of inflammatory skin disorders. Our observation that the EA found in Melianthus can induce severe contact allergy should caution for the possible dangers of specific allergic sensitizations to these increasingly used additives in natural medicines.
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Affiliation(s)
- Puneet Arora
- Department of Dermatology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Evin T Magner
- Department of Plant & Microbial Biology, University of Minnesota, St. Paul, MN, 55108, USA
| | - Paul L Bigliardi
- Department of Dermatology, University of Minnesota, Minneapolis, MN, 55455, USA.
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Podzimek S, Himmlova L, Janatova T, Bjørklund G, Vrbova R, Janovska M, Peana M, Chasapis CT, Vinsu A, Prochazkova J, Duskova J. Metal hypersensitivity and pro-inflammatory cytokine production in patients with failed orthopedic implants: A case-control study. Clin Immunol 2022; 245:109152. [DOI: 10.1016/j.clim.2022.109152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
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Fonacier L, Frankel D, Mawhirt S. Contact allergens for the allergist. Ann Allergy Asthma Immunol 2022; 128:629-644. [PMID: 35346877 DOI: 10.1016/j.anai.2022.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this article is to provide an overview and describe typically encountered skin contact allergens implicated in allergic contact dermatitis (ACD). DATA SOURCES Published literature obtained through textbooks, online PubMed, and Google Scholar database searches, author photography, and adapted figures were used. STUDY SELECTIONS Studies on the evaluation of ACD and specific skin contact allergens were selected, with a focus on original research articles and clinical reviews. RESULTS Major classifications of common contact allergens include the following: (1) fragrances, (2) preservatives, (3) excipients, (4) rubber chemicals, (5) textile dyes, (6) topical medications, and (6) metals and other biomedical device components. The dermatitis distribution can aid in identifying the suspected contact allergen culprit. Certain contact allergens have features that are important to consider in the patch testing (PT) interpretation; these include possible irritant reactions, false-negative reactions or missed detection, and delayed reactions. Fragrances, preservatives, and excipients are culprits in personal products and facial or neck dermatitis. Patch testing with fragrances, preservatives, and patient-supplied products requires careful interpretation. Hand or foot dermatitis may be attributed to rubber chemicals or textile dyes. The management of topical corticosteroid contact allergy is guided on the basis of structural group classifications. Metal sensitization has been associated with dermatitis or biomedical device complications. CONCLUSION Each skin contact allergen has unique characteristics with regard to the dermatitis clinical presentation and potential PT nuances. These features are critical to recognize in the evaluation of ACD and PT interpretation and clinical relevance, leading to an accurate diagnosis.
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Affiliation(s)
- Luz Fonacier
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, New York University Langone Hospital-Long Island, Mineola, New York; New York University Long Island School of Medicine, Mineola, New York.
| | - David Frankel
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, New York University Langone Hospital-Long Island, Mineola, New York
| | - Stephanie Mawhirt
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, New York University Langone Hospital-Long Island, Mineola, New York; New York University Long Island School of Medicine, Mineola, New York
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Koning JJ, Rodrigues Neves CT, Schimek K, Thon M, Spiekstra SW, Waaijman T, de Gruijl TD, Gibbs S. A Multi-Organ-on-Chip Approach to Investigate How Oral Exposure to Metals Can Cause Systemic Toxicity Leading to Langerhans Cell Activation in Skin. FRONTIERS IN TOXICOLOGY 2022; 3:824825. [PMID: 35295125 PMCID: PMC8915798 DOI: 10.3389/ftox.2021.824825] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Investigating systemic toxicity in vitro is still a huge challenge. Here, a multi-organ-on-chip approach is presented as a typical case of topical exposure of oral mucosa to metals, which are known to activate the immune system and in turn may result in skin inflammation. Reconstructed human gingiva (RHG) and reconstructed human skin containing MUTZ-3–derived Langerhans cells (MUTZ-LC) in the epidermis (RHS-LC) were incorporated into a HUMIMIC Chip3plus, connected by dynamic flow and cultured for a total period of 72 h. Three independent experiments were performed each with an intra-experiment replicate in order to assess the donor and technical variations. After an initial culture period of 24 h to achieve stable dynamic culture conditions, nickel sulfate was applied topically to RHG for 24 h, and LC activation (maturation and migration) was determined in RHS-LC after an additional 24 h incubation time. A stable dynamic culture of RHG and RHS-LC was achieved as indicated by the assessment of glucose uptake, lactate production, and lactate dehydrogenase release into the microfluidics compartment. Nickel exposure resulted in no major histological changes within RHG or RHS-LC, or cytokine release into the microfluidics compartment, but did result in an increased activation of LC as observed by the increased mRNA levels of CD1a, CD207, HLA-DR, and CD86 in the dermal compartment (hydrogel of RHS-LC (PCR)). This is the first study to describe systemic toxicity and immune cell activation in a multi-organ setting and can provide a framework for studying other organoids in the future.
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Affiliation(s)
- Jasper J Koning
- Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centre, Amsterdam Infection and Immunity Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charlotte T Rodrigues Neves
- Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centre, Amsterdam Infection and Immunity Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Maria Thon
- Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centre, Amsterdam Infection and Immunity Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sander W Spiekstra
- Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centre, Amsterdam Infection and Immunity Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Taco Waaijman
- Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centre, Amsterdam Infection and Immunity Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Tanja D de Gruijl
- Department of Medical Oncology, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Susan Gibbs
- Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centre, Amsterdam Infection and Immunity Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Oral Cell Biology, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Systemic contact dermatitis caused by a surgical glue. Postepy Dermatol Alergol 2021; 38:338-339. [PMID: 34408601 PMCID: PMC8362753 DOI: 10.5114/ada.2021.106215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 09/02/2019] [Indexed: 11/23/2022] Open
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Scheinman PL, Vocanson M, Thyssen JP, Johansen JD, Nixon RL, Dear K, Botto NC, Morot J, Goldminz AM. Contact dermatitis. Nat Rev Dis Primers 2021; 7:38. [PMID: 34045488 DOI: 10.1038/s41572-021-00271-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 02/04/2023]
Abstract
Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological mechanisms and/or requisite exposures. Clinical manifestations of CD vary widely and multiple subtypes may occur simultaneously. The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, which can negatively affect the quality of life of patients, systemic medications may be needed.
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Affiliation(s)
- Pamela L Scheinman
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marc Vocanson
- CIRI - Centre International de Recherche en Infectiologie, INSERM, U1111; Univ Lyon; Université Claude Bernard Lyon 1; Ecole Normale Supérieure de Lyon; CNRS, UMR, 5308, Lyon, France
| | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jeanne Duus Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rosemary L Nixon
- Skin Health Institute - Occupational Dermatology Research and Education Centre, Carlton, VIC, Australia
| | - Kate Dear
- Skin Health Institute - Occupational Dermatology Research and Education Centre, Carlton, VIC, Australia
| | - Nina C Botto
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Johanna Morot
- CIRI - Centre International de Recherche en Infectiologie, INSERM, U1111; Univ Lyon; Université Claude Bernard Lyon 1; Ecole Normale Supérieure de Lyon; CNRS, UMR, 5308, Lyon, France
| | - Ari M Goldminz
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
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Kageyama Y, Shimokawa Y, Kawauchi K, Morimoto M, Aida K, Akiyama T, Nakamura T. Evaluation of the SNP rs2367563 genotyping test as an adjunctive detection tool for dental metal hypersensitivity. AIMS ALLERGY AND IMMUNOLOGY 2021. [DOI: 10.3934/allergy.2021008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Baruffi FY, Venkatesh KP, Nelson KN, Powell A, Santos DM, Ehrlich A. Systemic Contact Dermatitis: A review. Dermatol Clin 2020; 38:379-388. [DOI: 10.1016/j.det.2020.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Torosyan Y, Spece H, Goodacre N, Azarbaijani Y, Marinac-Dabic D, Kurtz SM. In silico approaches for enhancing retrieval analysis as a source for discovery of implant reactivity-related mechanisms and biomarkers. J Biomed Mater Res B Appl Biomater 2019; 108:263-271. [PMID: 31012261 DOI: 10.1002/jbm.b.34386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/26/2018] [Accepted: 03/24/2019] [Indexed: 11/06/2022]
Abstract
The ability to characterize implant debris in conjunction with corresponding immune and tissue-destructive responses renders retrieval analysis as an important tool for evaluating orthopedic devices. We applied advanced analytics and in silico approaches to illustrate the retrieval-based potential to elucidate host responses and enable discovery of corresponding biomarkers indicative of in vivo implant performance. Hip retrieval analysis was performed using variables based on immunostaining, polarized microscopy, and fretting-corrosion and oxidation analyses. Statistical analyses were performed in R. Hierarchical/k-means clustering and principal component analysis were used for data analysis and visualization. Correlation Engine (CE) and Ingenuity Pathway Analysis (IPA) were employed for in silico corroboration of putative biomarkers. Higher giant cell and histiocyte scores and positivity for CD68 and CD3 indicating infiltration with macrophages and T-cells, respectively, were detected mainly among older generation hips with higher ultra-high-molecular-weight-polyethylene loads. Our in silico analysis using pre-existing data on wear particle-induced loosening substantiated the role of CD68 in implant-induced innate responses and identified the CD68-related molecular signature that can be indicative of development of aseptic loosening and can be further corroborated for diagnostic/prognostic testing in clinical setting. Thus, this study confirmed the great potential of advanced analytics and in silico approaches for enhancing retrieval analysis applications to discovery of new biomarkers for optimizing implant-related preclinical testing and clinical management. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:263-271, 2020.
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Affiliation(s)
- Yelizaveta Torosyan
- Center for Devices and Radiological Health, Office of Clinical Evidence and Analysis, Food and Drug Administration, Silver Spring, Maryland
| | - Hannah Spece
- Center for Devices and Radiological Health, Office of Clinical Evidence and Analysis, Food and Drug Administration, Silver Spring, Maryland.,Drexel University, Philadelphia, Pennsylvania
| | - Norman Goodacre
- Center for Devices and Radiological Health, Office of Clinical Evidence and Analysis, Food and Drug Administration, Silver Spring, Maryland
| | - Yasameen Azarbaijani
- Center for Devices and Radiological Health, Office of Clinical Evidence and Analysis, Food and Drug Administration, Silver Spring, Maryland
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health, Office of Clinical Evidence and Analysis, Food and Drug Administration, Silver Spring, Maryland
| | - Steven M Kurtz
- Drexel University, Philadelphia, Pennsylvania.,Exponent, Inc., Philadelphia, Pennsylvania
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Suwarsa O, Rahardjo RM, Sutedja E, Dharmadji HP, Hindritiani R, Gunawan H. Systemic contact dermatitis due to corrosion of titanium-coated nickel and cobalt bone plate fixation: A case report. Medicine (Baltimore) 2017; 96:e9120. [PMID: 29390311 PMCID: PMC5815723 DOI: 10.1097/md.0000000000009120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Corrosion refers to the degradation of a material that occurs following its interaction with other substances in the environment. Corrosion of metallic substances into tissues may lead to inflammatory responses such as systemic contact dermatitis (SCD), a skin condition where an individual who has previously been sensitized to a particular allergen via the cutaneous route will subsequently react to same allergen via the systemic route. This condition occurs following exposure to allergens such as metals, medications, and certain food substances. In recent years, the use of metal plates for internal fixation has become increasingly common in bone fracture repairs. PATIENT CONCERNS A 34-year-old Indonesian male presented with systemic erythema with itching 7 days following a bone plate fixation as a management for mandibular fracture. DIAGNOSES Physical examination showed pruritic red macules, papules, and scales on almost his entire body, along with facial swelling. The patch test results revealed a positive reaction to nickel and cobalt. Therefore, the patient was diagnosed with SCD. INTERVENTIONS The patient was treated with topical and systemic corticosteroids as well as bone plate removal. OUTCOME After treatment, the eruption turned brown, the itching was resolved, and there were no facial swelling as well. LESSONS This case report highlights the need to consider the occurrence of SCD in patients following bone plate fixation.
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Cobb HK, Shinohara MM, Huss JT, Welch MP, Gardner JM. Systemic contact dermatitis to a surgical implant presenting as red decorative tattoo reaction. JAAD Case Rep 2017; 3:348-350. [PMID: 28761918 PMCID: PMC5521023 DOI: 10.1016/j.jdcr.2017.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hana K Cobb
- University of Washington School of Medicine, Seattle, Washington
| | - Michi M Shinohara
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington
| | - Jason T Huss
- VA Puget Sound Healthcare System Department of Podiatry, Seattle, Washington
| | - Marshall P Welch
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington
| | - Jennifer M Gardner
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington
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Wawrzynski J, Gil JA, Goodman AD, Waryasz GR. Hypersensitivity to Orthopedic Implants: A Review of the Literature. Rheumatol Ther 2017; 4:45-56. [PMID: 28364382 PMCID: PMC5443731 DOI: 10.1007/s40744-017-0062-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Indexed: 12/18/2022] Open
Abstract
Awareness of rare etiologies for implant failure is becoming increasingly important. In addition to the overall increase in joint arthroplasties, revision surgeries are projected to increase dramatically in the coming years, with volume increasing up to seven-fold between 2005 and 2030. The literature regarding the relationship between metal allergy and implant failure is controversial. It has proven difficult to determine whether sensitization is a cause or a consequence of implant failure. Testing patients with functional implants is not a clinically useful approach, as the rate of hypersensitivity is higher in implant recipients than in the general population, regardless of the status of the implant. As a result of the ineffectiveness of preoperative patch testing for predicting adverse outcomes, as well as the high cost of implementing such patch testing as standard procedure, most orthopedists and dermatologists agree that an alternative prosthesis should only be considered for patients with a history of allergy to a metal in the standard implant. In patients with a failed implant requiring revision surgery, hypersensitivity to an implant component should be considered in the differential diagnosis. Because a metal allergy to implant components is currently not commonly considered in the differential for joint failure in the orthopedic literature, there should be improved communication and collaboration between orthopedists and dermatologists when evaluating joint replacement patients with a presentation suggestive of allergy.
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Affiliation(s)
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - Avi D Goodman
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Gregory R Waryasz
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Prosthetic and Device Surgery Considerations. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Minimally invasive coronary bypass in a patient with metal allergy. Can J Cardiol 2015; 31:364.e3-4. [PMID: 25595031 DOI: 10.1016/j.cjca.2014.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 11/30/2014] [Accepted: 11/30/2014] [Indexed: 11/22/2022] Open
Abstract
Patients with metal allergy represent a challenge for current surgical techniques, particularly minimally invasive ones, in which metal implants are routinely used to facilitate procedures. We report on a 60-year-old woman with metal allergy who presented with non-ST elevation myocardial infarction, and in whom we performed minimally invasive coronary artery bypass via small thoracotomy. In conclusion, we show that minimally invasive coronary surgery might feasibly be done without the aid of metal implants or surgical clips for hemostasis.
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Wong CC, Nixon RL. Systemic allergic dermatitis caused by cobalt and cobalt toxicity from a metal on a metal hip replacement. Contact Dermatitis 2014; 71:113-4. [DOI: 10.1111/cod.12267] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/08/2014] [Accepted: 05/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Celestine C. Wong
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc.; Carlton Victoria 3053 Australia
| | - Rosemary L. Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc.; Carlton Victoria 3053 Australia
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A case study involving allergic reactions to sulfur-containing compounds including, sulfite, taurine, acesulfame potassium and sulfonamides. Food Chem Toxicol 2013; 63:240-3. [PMID: 24262485 DOI: 10.1016/j.fct.2013.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 11/07/2013] [Accepted: 11/11/2013] [Indexed: 11/21/2022]
Abstract
A case study is reported whereby an individual with known sulfite and sulfonamide allergies develops hypersensitivity to taurine above a threshold level as well as to the non-nutritive sweetener acesulfame potassium, compounds that are not normally associated with allergic reactions. Sulfites, sulfonamides, taurine and acesulfame potassium all contain a SO3 moiety. Challenge tests provide evidence for the hypersensitivities to taurine and acesulfame potassium. The subject is also allergic to thiuram mix and thimerosal, sulfur containing compounds, as well as to various food products. This may be the first case where hypersensitivities to taurine and acesulfame potassium have been documented and reported. Several mechanistic explanations are provided for the untoward reactions to taurine and acesulfame potassium.
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