Allergic contact dermatitis to gold in the parts of in‐ear headphones

Abstract

As our patientʼs rash closely coincided with the distribution of the reflective tape and subsequently improved upon restricting his exposure to the tape, possible causes included irritant contact dermatitis (ICD) or a lichenoid allergic contact dermatitis (ACD). Despite the interface dermatitis reaction pattern observed on histology, we favour the diagnosis of ICD to the reflective tape, based on his negative patch test result with cut-outs from the reflective tape of his shirt and the absence of the identified allergens in its composition. We hypothesize that excessive sweating and the occlusive nature of the tape may have been factors contributing to his reaction. An ongoing lichenoid ACD secondary to residual sodium metabisulfite or benzalkonium chloride in the tape seems less likely, particularly as disinfection measures involving those allergens could not be definitively confirmed. High-visibility reflective tape has only previously been implicated in the medical literature for causing first-degree burns of the mid-back, secondary to overheating in sunny conditions. 1 To our knowledge, this is the first report of high-visibility reflective tape potentially inducing ICD. Frank Po-Chao Chiu: Conceptualization (equal); data curation (equal); formal analysis (equal); investigation (equal); methodology (equal); project administration (equal); writingoriginal draft (equal); writingreview and editing (equal). rosemary nixon: Formal analysis (equal); investigation (equal); methodology (equal); supervision (equal); writingoriginal draft (equal); writingreview and editing (equal). Adriene Lee: Formal analysis (equal); investigation (equal); supervision (equal); writing review and editing (equal). Aaron Edward Boyce: Conceptualization (equal); data curation (equal); formal analysis (equal); investigation (equal); methodology (equal); resources (equal); supervision (equal); writingoriginal draft (equal); writingreview and editing (equal).

Wireless over‐ear headphones: A new source of allergic contact dermatitis to isothiazolinones

“…Despite the increasing fashion of wireless headphones, our case is the first report of ACD to wireless over‐ear headphones, since the only four previously reported cases were caused by in‐ear headphones 2–5 . Moreover, in these few cases, isothiazolinones were never reported as culprit allergens.…”

“…The advances in wireless audio technology increased the Bluetooth headphone use to enhance mobility, to redefine connection with cellphones and to improve audio quality. Cases of ACD to wireless headphones were rarely reported, and they all were caused by in‐ear headphones due to gold 2 and acrylates 3–5 …”

Allergic contact dermatitis to in‐ear headphones occurring in the external ear

“…However, other reports did not detect any specific substance. [3][4][5] The limited availability of information on the constituents of these devices complicates the diagnostic process for physicians, making it challenging to identify or even suspect these devices as the cause of contact dermatitis.…”

“…In previous reports of contact dermatitis related to in‐ear headphones or hearing aids, some cases were suspected to be linked to materials such as rubber, gold, dyes, acrylates, and methacrylates. However, other reports did not detect any specific substance 3–5 . The limited availability of information on the constituents of these devices complicates the diagnostic process for physicians, making it challenging to identify or even suspect these devices as the cause of contact dermatitis.…”

Metal Allergy: State-of-the-Art Mechanisms, Biomarkers, Hypersensitivity to Implants

“…A mono-positive PT revealed gold (Au) hypersensitivity, also the headphones he was using contained Au-plated metal parts. After stopping using them, there was no recurrence of symptoms [ 42 ]. Iron (Fe) can be a relevant sensitizer, especially in complicated knee arthroscopy [ 43 ].…”