Metal implants can play havoc with skin

An allergy to metal should be considered when considering medical implants like joint replacements and cardiac devices.

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Doctors in the US are reporting more cases of skin hypersensitivity to nickel and other metals used in implanted medical devices, delegates at the American Academy of Dermatology’s Annual Meeting in New Orleans were told last week.

Clinical Associate Professor Golara Honari, of Stanford University, said millions of people in the US report having a metal allergy and an estimated 10% of Americans receive a medical implant in their lifetime, so the increase comes as little surprise.

“Metal — nickel in particular — is one of the most common culprits of allergic contact dermatitis,” she said.

“This condition occurs when the affected skin is exposed to an allergen, often leading to patients’ skin itching and followed by the development of a rash.

“Cases in which patients are inquiring about a metal allergy as it relates to their metal implants — including joint replacements, rods, pins, screws, plates, certain neurologic and cardiac devices such as pacemakers, and dental devices — are becoming more prevalent as medical implants become more common.”

Skin symptoms of contact allergy from metal implants include rash, intense itching, dryness, hives, blisters, or pain.

Dr Honari said because immune systems react to allergens differently from person to person, suspected metal implant allergies could be challenging to diagnose and manage without the close collaboration between a dermatologist and the surgeon or other physician who placed the implant.

For patients who may need an implant and have a documented history of a metal allergy, Dr Honari recommended notifying a dermatologist.

“There are alternatives to metal implants,” she said.

“For example, if it’s an orthopaedic implant, there are ceramic options, which won’t affect those who have a metal allergy.

“There must be a very close relationship between the surgeon and dermatologist as they work together to consider if a patient needs a different type of implant or if they should be tested for metal allergies prior to surgery.”

Patients should be encouraged to take note of any skin symptoms after implantation and discuss these with a dermatologist and surgeon.

“A thorough investigation is necessary to rule out more common causes of inflammation such as infection,” said Dr Honari.

“However, if an allergic reaction is suspected, the first line of treatment may be topical and/or oral medications, like anti-inflammatories, which can relieve pain, reduce inflammation, and bring down a high temperature. Often, when a metal implant is put into the body, it releases some amount of metal for a certain period of time, which can cause irritation in people who have metal allergies. In many cases, this release slows down, and patients are able to keep the implant.”

If the issue doesn’t resolve, other options — such as removal of the implant — may be considered on a case-by-case basis, said Dr Honari.