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Manganese Oxidation State as a Cause of Irritant Patch Test Reactions

Shallcross, Laurie MD*; Ritchie, Simon MD*; Harberts, Erin BA*†; Tammaro, Antonella MD; Gaitens, Joanna PhD§; Gaspari, Anthony A. MD*†

doi: 10.1097/DER.0000000000000032

Background Manganese chloride (MnCl2) 2.5% is included in the extended metals patch test series to evaluate patients for contact hypersensitivity to this metal salt.

Objectives The objective of this study was to prospectively determine the rate of allergic and irritant patch test reactions to MnCl2 (Mn(II)), Mn2O3 (Mn(III)), and KMnO4 (Mn(VII)) in a cohort of patients undergoing patch testing.

Methods Fifty-eight patients were patch tested with MnCl2, Mn2O3, and KMnO4, each at 2.5% in petrolatum. Patch readings were taken at 48, and 72 or 96 hours, and scored using standard methods. Cultured monolayers of keratinocytes (KCs) were exposed to MnCl2, Mn2O3, and KMnO4 in aqueous culture medium, and cell survival and cytokine release were studied.

Conclusions MnCl2 caused irritant patch test reactions in 41% of the cohort, whereas Mn2O3 and KMnO4 caused a significantly lower rate of irritant reactions (both 3%). No allergic morphologies were observed. Similarly, in cultured KC monolayers, only MnCl2 was cytotoxic to KC and induced tumor necrosis factor α release.

The oxidation state of manganese used for patch testing affects the irritancy of this metal salt, as Mn(II) caused an unacceptably high rate of irritant reactions in a cohort of patients. In vitro studies confirmed these clinical data, as only Mn(II) was cytotoxic to cultured monolayers of KC.

From the Departments of *Dermatology and †Microbiology/Immunology, University of Maryland School of Medicine, Baltimore MD; ‡Department of Dermatology, La Sapienza University, Rome, Italy; and §Department of Medicine, University of Maryland School of Medicine, Baltimore MD.

Address reprint requests to Anthony A. Gaspari, MD, 419 W Redwood St, Suite 240, Baltimore, MD 21201. E-mail:

© 2014 American Contact Dermatitis Society
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