ImplantDermatitisAmberReckAtwater,MDF028–AdvancedPatchTesting:PearlsfromtheACDSThemostcommontypesofimplantsthatrequireevaluationinpatchtestclinicsareorthopedic,cardiacanddentaldevices.Reviewofpatchtestingforhypersensitivitytoimplantedmetaldevices:Dermatitis2016;27(5):241-47.Pre-implanttesting:• Routinetestingnotrecommended• Self-reportedhistoryofintolerancetojewelrynotadequatescreen• 2screeningquestionsfornickel:

• Areyousensitive,hyper-sensitive,orallergictonickel?PPV59%• Doyougetarashfrommetalbuttons,jewelry,orothermetalitemsthatcomeindirect

contactwithyourskin?PPV60%• Ifpatientstronglybelievesallergic,considerpatchtesting

Post-implanttesting:Majorandminorcriteriaformetalhypersensitivityreactionafterimplantation:

ImplantPatchTestPanels:• Commerciallyavailable“MetalImplants”Panel• NACDGscreeningseries• Orthopedic

• ContactDermatitis2011;66:4–19• Dermatitis2011;22:65–79• ArchivesofDermatology2012;148:687-693

• Cardiac• ContactDermatitis2008;59:7–22

• Dental• DentalScreeningPanels

• ArchivesofDermatology2004;140:1434-1438• DermatologicTherapy2010;23:251–267

OrthopedicImplantsMaterialstoconsider:• Metals:vitallium,stainlesssteel,titanium,nitinol,oxinium• BonecementandotheradditivesTypesofreactions:• Localizeddermatitis• Generalizeddermatitis• Noncutaneouscomplications

SeeArchDermatol.2012;148(6):687-693.CardiacImplants:Stents:• Thereisacorrelationbetweengoldstentsandincreasedriskofin-stentrestenosis.• Thereisnotanincreasedriskofin-stentrestenosiswithnickelorchromium.Pacemakersanddefibrillators:• ReactionstoTitanium,Nickel,Cobalt,Chromium,Mercury,Epoxy,Polychloroparaxylene

(parylene),Polyurethane,Polysulfonebeige,ThiurammixandSiliconeadhesivehavebeenreported.

• ClinicalpresentationsincludeLocalizederythema,Concernforinfection,DeviceExtrusion,Pain,Pruritus.

• Patientsmaypresentwithbilateralscarsonchestfrommultipledeviceextractions.• Devicecompaniescancustom-builddevices;polytetrafluoroethylene(PTFE)coatingshave

hadsomesuccess.DentalImplants:• ClinicalpresentationsincludeLichenplanus,stomatitis,Periodontitis,Cheilitis,Aphthous

ulcers,Glossodynia,Burningmouth/tongue,Gingivitis.Mostcommonarelichenplanusandstomatitis.

• Inonestudy,22%ofpatientswhopresentedwithstomatitisand14%ofpatientswhopresentedwithlichenplanushadapossiblecontactallergy.

Orallichenplanus:• CommonallergensincludeGold,Amalgam(mercury),Palladium,Copper,Silver,Acrylates• 8of13patientswithlichenplanusandpositivepatchtesttometalshadimplantremoved

andwereasymptomaticat1year.• Patientswithpospatchtomercurycompoundsandlesionsadjacenttoandupto1cmaway

fromimplanthadimplantremovedandmostimprovedorwereclear.Iflesionswerefurtheraway,likelihoodofpospatchwaslowerandpatientsalsolesslikelytoimprovewithremovalofimplant.

Contactstomatitis:

• Thetermstomatitisrepresentsdifferenttypesofclinicaloralpresentationsofallergic

contactdermatitis• Hasbeenreportedwithacrylates,metalsandwithdifferenttypesofimplants(crowns,

orthodontics,prostheses,fillings)SelectReferences:Dermatitis2016;27(5):241-47Dermatitis2013;24(6):313-320Dermatitis2013;24(4):183-185Dermatitis2011;22:65-79ContactDermatitis2011;64:138-41ContactDermatitis2010;62:289-293ContactDermatitis2009;60:158-164ContactDermatitis2009:60:339–343ContactDermatitis2008;59:7-22ContactDermatitis2003;49:264-265PACE1997:20:372-373JArtificialOrgans2014;17:285–287ArchDermatol.2012;148(6):687-693ArchDermatol.2004;140:1434-1438Implantpatchtestpublicationslistedabove