Allergic contact granuloma due to palladium following ear piercing

Abstract

Two cases of sarcoidal-type allergic contact granuloma due to metals in ear piercing are presented, the first to palladium (Pd) only, and the second to Pd and possibly also to other metals. Both the patients developed papulonodular lesions at the helices following ear piercing, which after 3-4 weeks, became more granulomatous and very resistant to treatment. Indeed, repeated intralesional injections with corticosteroids produced only a temporary regression of the lesions. Biopsies from the persistent granulomatous lesions from the helices in both the patients and the positive test to Pd in case 2, 3 weeks after the patch-testing procedure, demonstrated epithelioid granulomas, with some multinucleate histiocytes surrounded by a lymphocytic-histiocytic infiltrate. Areas of fibrinoid necrosis were found in both the helix biopsies. An infectious pathology was excluded. Patch testing showed a strong positive reaction to Pd only in case 1 and to Pd and nickel in case 2. Chemical analysis of the earring of patient 1 confirmed the presence of Pd; however, analysis of the earrings of the second patient did not show the presence of Pd, but showed the presence of nickel and copper. Both the clinical and histological findings concur with some rarely reported similar observations in the literature.

Palladium‐induced granulomas analysed with inductively coupled plasma mass spectrometry

“…Similar cases have been described in the literature, in which granulomas have been found in the earlobe with a positive reaction to palladium after patch testing . The presence of palladium has been confirmed in earrings, and is a likely source of this reaction .…”

“…Skin penetration and permeation of palladium nanoparticles in the epidermis and dermis has been shown in damaged skin . Other cutaneous granulomas have also been reported to be induced by beryllium and zirconium, and in these cases metals have been found in the skin …”

Unexpected loss of contact allergy to aluminium induced by vaccine

“…It is more likely that the sensitization reaction to aluminium has led to the granuloma formation. Sarcoidal‐type allergic contact granuloma was first described in 1983 from gold earrings (30) Palladium‐induced contact granuloma has also been reported (31). Case reports of injected aluminium in a tattoo or cosmetic eyebrows have been described (32, 33).…”

Variety of complications after auricle piercing

“…Saraf estimates that minor complications of body piercing in the site of the auricle appear in about 20% of patients, while serious complications are observed in only 3% . Persons with atopic dermatitis or allergic metal contact dermatitis are at increased risk of complications, especially local staphylococcal or streptococcal skin infections In addition, development of granuloma as an allergic reaction is possible after ear piercing . Those lesions can be similar to sarcoidal‐type granuloma with confluent areas of fibrinoid necrosis .…”