Tuesday, October 18, 2011

Cutaneous and systemic hypersensitivity reactions to metallic implants

Dermatitis. 2011 Apr;22(2):65-79.


Basko-Plluska JL, Thyssen JP, Schalock PC.


Department of Medicine, Section of Dermatology, The University of Chicago, Chicago, IL, USA.


Cutaneous [skin] reactions to metal implants, orthopedic or otherwise, are well documented in the literature. The first case of a dermatitis reaction over a stainless steel fracture plate was described in 1966. Most skin reactions are eczematous and allergic in nature, although urticarial, bullous, and vasculitic eruptions may occur. Also, more complex immune reactions may develop around the implants, resulting in pain, inflammation, and loosening. Nickel, cobalt, and chromium are the three most common metals that elicit both cutaneous and extracutaneous allergic reactions from chronic internal exposure. However, other metal ions as well as bone cement components can cause such hypersensitivity reactions. To complicate things, patients may also develop delayed-type hypersensitivity reactions to metals (ie, in-stent restenosis, prosthesis loosening, inflammation, pain, or allergic contact dermatitis) following the insertion of intravascular stents, dental implants, cardiac pacemakers, or implanted gynecologic devices. Despite repeated attempts by researchers and clinicians to further understand this difficult area of medicine, the association between metal sensitivity and cutaneous allergic reactions remains to be fully understood. This review provides an update of the current knowledge in this field and should be valuable to health care providers who manage patients with conditions related to this field.

[From Connie : Interesting that the 2 of the 3 most common metals that elicit reactions from chronic internal exposure are Chromium and Cobalt.  Unfortunate that we just don't know what the long term systemic "reactions" are at this point.]

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