Patch Testing for Implanted Medical Device-Related Delayed Hypersensitivity Reactions: Retrospective Analysis of North American Contact Dermatitis Group Data, 2016–2022
Amber Reck Atwater, Beiyu Liu, Cynthia L. Green, Erin M. Warshaw, Margo J. Reeder, Brandon L. Adler, Melanie D. Pratt, Joseph F. Fowler, James S. Taylor, Marie-Claude Houle, Jonathan I. Silverberg, Peggy A. Wu, Donald V. Belsito, Cory A. Dunnick, Jonathan Zippin, Christen Mowad, Howard I. Maibach, Nina Botto, JiaDe Yu, Joel G. DeKovenBackground:
Medical implants are often suspected of causing allergic reactions.
Objective:
To determine results for 2016–2022 North American Contact Dermatitis Group implant patch testing.
Methods:
Retrospective, cross-sectional analysis of clinical findings and patch test results.
Results:
Of 128 Pre-implant cases, 57.8% had ≥1 positive patch test reaction (PPTR). Top implant sites were knee and hip (62.7%). Top PPTRs were nickel 5% (43.0%), nickel 2.5% (29.1%), vanadium (14.3%), and cobalt (11%). Of 170 Post-implant cases, 45.3% had no dermatitis, 29.8% had dermatitis at the implant site, and 14.9% had scattered/generalized distribution. Top implant sites were knee and hip (66.8%). There was ≥1 PPTR in 35.9% of patients. 27/43 (62.8%) allergens ever tested positive, and of these, 77.8% (21/27) had current relevance. Top PPTR were nickel 5% (16.5%), nickel 2.5% (12.9%), cobalt (6.5%), and neomycin (5.9%). Of 170 cases, 18 (10.6%) were diagnosed with allergic contact dermatitis at implant site due to implant, with top allergens titanium oxalate (n = 4), tobramycin (n = 3), cobalt (n = 3), and nickel 5% (n = 3).
Conclusions:
Over half of Pre-implant and just over 1/3 of Post-implant patients had ≥1 PPTR. About 10% of Post-implant patients were diagnosed with allergic contact dermatitis at implant site due to implant. Outcomes data are needed to confirm relevance.