Systemic Contact Dermatitis and Allergy to Biomedical Devices

Abstract

Systemic contact dermatitis (SCD) refers to a skin condition where an individual who is cutaneously sensitized to an allergen will subsequently react to that same allergen or a cross-reacting allergen via the systemic route. It occurs to allergens including metals, medications, and foods. There has been recent interest in metal allergy as it relates to the implantation of devices such as orthopedic, dental, cardiac, and gynecologic implants. This review will briefly address all causes of systemic contact dermatitis with a special and expanded focus on metal implant allergy. We present literature on SCD to various metal biomedical devices, patch testing for diagnosis of metal allergy pre and post implantation and treatment.

In silicoapproaches for enhancing retrieval analysis as a source for discovery of implant reactivity‐related mechanisms and biomarkers

“…Consequently, biomedical knowledge on chitin‐induced PAMPs may help clarify the implant‐related DAMPs. Since chitin is expressed by pathogens inducing skin allergy and chitin‐keratinocyte interactions are implicated in the regulation of epidermal immunity, CD68‐associated chitin response may particularly highlight the role of innate immunity in skin reactions and thus may clarify the overall nature of implant‐related hypersensitivity, or “allergy,” conventionally limited to adaptive immunity …”

Systemic contact dermatitis to a surgical implant presenting as red decorative tattoo reaction

“…Criteria to support a link between metal allergy and metal dermatitis have been proposed: (1) dermatitis beginning weeks to months after implantation; (2) an eruption overlying the implant with erythema, induration, papules, or vesicles; (3) positive patch test results to a metal used in the implant; (4) positive in vitro testing to metals; (5) a dermatitis that is resistant to medical therapy; and (6) complete recovery after removing the implant 3 . Management after diagnosis of metal hypersensitivity is controversial with no clear objective criteria.…”

“…For symptomatic individuals with refractory dermatitis and for whom device removal is considered reasonable, the device may be removed. In individuals for whom implant removal is not possible, a tapered dose of oral prednisone over 21 days may be helpful 1, 2, 3. For tattoo-related dermatitis, varying degrees of success with oral allopurinol, topical and intralesional corticosteroids, antibiotics, surgical excision, and laser have been reported 4, 7, 8, 9…”

“…SCD occurs when an individual cutaneously sensitized to an allergen subsequently reacts to that allergen systemically. SCD is rare but should be given special consideration in patients with known metal allergies and those who present with postoperative complications such as pain or implant loosening 1, 2, 3. Hallab et al 10 found a weighted mean prevalence of hypersensitivity to nickel, cobalt, or chromium in 25% of patients with well-functioning hip arthroplasties compared with a prevalence of 60% of patients with a failed or poorly functioning hip implant.…”

“…Hallab et al 10 found a weighted mean prevalence of hypersensitivity to nickel, cobalt, or chromium in 25% of patients with well-functioning hip arthroplasties compared with a prevalence of 60% of patients with a failed or poorly functioning hip implant. Common symptoms include dermatitis at the implant site, implant loosening, impaired healing, and joint pain 1, 2, 3, 11…”