Metal Allergy and Systemic Contact Dermatitis: An Overview

Abstract

Contact dermatitis is produced by external skin exposure to an allergen, but sometimes a systemically administered allergen may reach the skin and remain concentrated there with the aid of the circulatory system, leading to the production of systemic contact dermatitis (SCD). Metals such as nickel, cobalt, chromium, and zinc are ubiquitous in our environment. Metal allergy may result in allergic contact dermatitis and also SCD. Systemic reactions, such as hand dermatitis or generalized eczematous reactions, can occur due to dietary nickel or cobalt ingestion. Zinc-containing dental fillings can induce oral lichen planus, palmoplantar pustulosis, and maculopapular rash. A diagnosis of sensitivity to metal is established by epicutaneous patch testing and oral metal challenge with metals such as nickel, cobalt, chromium, and zinc. In vitro tests, such as the lymphocyte stimulating test (LST), have some advantages over patch testing to diagnose allergic contact dermatitis. Additionally, the determination of the production of several cytokines by primary peripheral blood mononuclear cell cultures is a potentially promising in vitro method for the discrimination of metal allergies, including SCD, as compared with the LST.

Metal sensitivity in patients before and after total knee arthroplasty (TKA): comparison between ceramic surfaced oxidized zirconium and cobalt-chromium implants

“…In addition, mixing metal chlorides used in patch testing has the potential of inducing hypersensitivity by extended dermal contact during patch testing. Therefore, although the use of LST in the assessment of MS is currently less popular than patch testing, several studies indicate that LST may have advantages over dermal patch testing for implant related hypersensitivity [19,20].…”

An overview of zinc and its importance in dermatology-Part II: The association of zinc with some dermatologic disorders

“…In dental restoration, Zn has been used for many years [125]. Zn in this form can cause oral LP [125,126], a maculopapular rash, and systemic contact dermatitis [125].…”

“…Zn in this form can cause oral LP [125,126], a maculopapular rash, and systemic contact dermatitis [125]. It appears that the complications due to Zn in the dental metal are low.…”

“…Controversially, there are reports that have shown that dental Zn restoration can cause palmoplantar pustulosis [125,137]. Nielsen and Menné reported an eruption of pustular Ps in a patient with stable Ps secondary to allergic contact dermatitis following the use of Zn pyrithione shampoo [138].…”

Review of Occupational Contact Dermatitis—Top Allergens, Best Avoidance Measures

“…While most patients and providers are aware of cutaneous contact dermatitis to nickel, oral intake of nickel found in many foods has been linked to systemic contact dermatitis [37,38].…”