Nickel release from metals, and a case of allergic contact dermatitis from stainless steel

Abstract

The prevalence of allergic contact dermatitis (ACD) caused by nickel is increasing. The probable cause is the increased use of nickel-containing metals in intimate contact with the skin. The critical factor is the amount of nickel released from these metals (bioavailable nickel) onto the skin. In the present study, we determined, with flame atomic absorbtion spectrometry, the amount of nickel released into synthetic sweat from metal samples. The results of this method were compared with the results of the dimethylglyoxime (DMG) test, which is considered to be a reliable means of identifying whether nickel-containing metals may cause allergy symptoms in sensitive individuals. Out of 10 samples studied, only small amounts (< 0.5 microgram/cm2/week) were released from 2 samples, and the DMG test was negative. From 5 samples, more than 0.5 microgram/cm2/week was released, and the DMG test was positive. For 3 samples, however, the DMG test was negative, though the flame atomic absorption spectrometry test showed considerable release of nickel. Therefore, although the DMG test can be used as a first line test for determining nickel release, some DMG-negative metal materials probably induce nickel sensitization, and should by no means be advertised as safe in this respect. We also report a nickel-allergic patient who developed ACD from stainless steel, indicating that some types of stainless steel release enough nickel to elicit allergic symptoms.

Stainless Steel: Material Facts for the Orthodontic Practitioner

“…They also reported a higher prevalence of nickel allergy in girls, which is also reported in other papers [56,57]. Although orthodontic alloys are considered safe, there are case reports on nickel hypersensitivity caused by orthodontic appliances, both from stainless steel and nickel-titanium alloys [50,[58][59][60]. Common intra-oral signs include redness, swelling, and soreness of the oral mucosa and palate, gingiva and lips [59].…”

Nickel release from earrings purchased in the United States: The San Francisco earring study

“…20 The sensitivity of the DMG test has previously been questioned because false-negative reactions have been identified. 19,22,[24][25][26] In case of suspected false-negative DMG reaction, the surface may be pretreated with artificial sweat to dissolve the protective layer. 9,26 Ponka and Ekman 26 demonstrated that 9 (14%) of 66 DMG-negative earrings became DMG positive after treatment with artificial sweat.…”

Lymphocyte responses in patients with total hip arthroplasty

“…cell-mediated hypersensitivity) associated with metal components may be partly responsible for this differential reactivity. The most common orthopaedic soluble metal (ions) sensitizers include nickel, Ni, [16,23,30,35] cobalt, Co, [35] and chromium, Cr, [35] while occasional responses have been reported to tantalum, Ta, [ 11 titanium, Ti, [33,43] and vanadium, V [l]. Nickel is the most common metal sensitizer in humans followed by Co and Cr [2,16,23,30] and cross reactivity between Ni and Co is common [2].…”

“…The most common orthopaedic soluble metal (ions) sensitizers include nickel, Ni, [16,23,30,35] cobalt, Co, [35] and chromium, Cr, [35] while occasional responses have been reported to tantalum, Ta, [ 11 titanium, Ti, [33,43] and vanadium, V [l]. Nickel is the most common metal sensitizer in humans followed by Co and Cr [2,16,23,30] and cross reactivity between Ni and Co is common [2]. The incidence of metal sensitivity among the general population is approximately 10% and among patients with well functioning and poorly functioning implants is approximately 25% and 6O%, respectively, in reported compiled analyses of numerous investigations [ 191. What remained poorly characterized were the specific metals that mediate implant related metal hypersensitivity reactions, the incidence of THA metal hypersensitivity using modern immunological testing methods and the relation of metal hypersensitivity to implant performance.…”