Contact dermatitis can be a complication of metal implants

About 10% of people in the United States will receive a medical implant in their lifetime, and more and more dermatologists are seeing patients who have a skin reaction associated with the metals used in these implants, according to a session held today at the annual meeting of the American Academy of Dermatology Association in New Orleans.

The metals used, especially nickel, are the most common culprits of allergic contact dermatitis, the presenter said Golara Honari, MD, Clinical Associate Professor of Dermatology at Stanford School of Medicine. “Cases in which patients inquire about a metal allergy with respect to their metal implants – including joint replacements, rods, pins, screws, plates and certain neurological and cardiac devices such as pacemakers and braces – are becoming more common as medical implants become more common Honari said it’s unclear what proportion of patients develop these reactions, although they are relatively rare.

“Skin reactions can be localized. Sometimes they can be systemic, and they can have other morphologies as well,” she noted.

The use of metal implants is growing. The US medical device market was $177.06 billion in 2021 and is expected to reach $255.14 billion in 2029, Honari said in his presentation. Joint replacement surgeries continue to grow at approximately 5% per year with a market value of $19 billion in 2021. In the United States, there are approximately 450,000 hip replacement surgeries per year, and this figure is expected to rise to 572,000 per year by 2030. There are approximately 790,000 knee replacement surgeries each year in the United States and this figure is expected to rise to 3.48 million by 2030. Additionally, more than 2 million vascular stents are established in the United States.

Implanted devices can sometimes corrode and chemicals can leak into the body. It can elicit an immune response, but the interactions between the materials and the body are complex, Honari said. Reactions can include hypersensitivity, chronic inflammation, immune suppression, immunostimulation, and autoimmunity.

For hip and knee replacements, skin and systemic reactions may occur weeks to months after implantation. The most common are localized reactions which present as dermatitis affecting the skin at the implant site.

Nickel is the most common contact allergen and its incidence, particularly among children tested in the United States, has almost quadrupled over the past three decades. Chromium is the third most common allergen in the population. Titanium is generally considered biocompatible but can cause a rare reaction. Honari said she has seen allergic reactions to the bone cement sometimes used in surgeries.

Honari recommends that patients who have a history of metal allergies consider patch testing before surgery. After surgery, she recommends ruling out inflammation if a patient experiences an allergic reaction. “However, if an allergic reaction is suspected, the first line of treatment may be topical and/or oral medications, such as anti-inflammatories, which can relieve pain, reduce inflammation, and bring down a high temperature,” he said. she declared.