The American Contact Dermatitis Society recognizes the interest in the evaluation and management of metal hypersensitivity reactions. Given the paucity of robust evidence with which to guide our practices, we provide reasonable evidence and expert opinion–based guidelines for clinicians with regard to metal hypersensitivity reaction testing and patient management. Routine preoperative evaluation in individuals with no history of adverse cutaneous reactions to metals or history of previous implant-related adverse events is not necessary. Patients with a clear self-reported history of metal reactions should be evaluated by patch testing before device implant. Patch testing is only 1 element in the assessment of causation in those with postimplantation morbidity. Metal exposure from the implanted device can cause sensitization, but a positive metal test does not prove symptom causality. The decision to replace an implanted device must include an assessment of all clinical factors and a thorough risk-benefit analysis by the treating physician(s) and patient.
From the *Department of Dermatology, Massachusetts General Hospital, Harvard School of Medicine, Boston; †Department of Dermatology, University of Pennsylvania, Philadelphia; ‡University Hospitals Case Medical Center, Cleveland, OH; §Department of Dermatology, Brigham and Women’s Hospital, Harvard School of Medicine, Boston, MA; ∥Duke Dermatology, Duke University Medical Center, Durham, NC; ¶Department of Dermatology, Geisinger Health System, Danville, PA; #Department of Dermatology, George Washington University, Washington, DC; **Yale University School of Medicine, New Haven, CT; ††Division of Dermatology, McGill University Health Centre, Montréal, Quebec, Canada; ‡‡Division of Dermatology, UMass Memorial Medical Center, Worcester; §§University of Illinois at Chicago; ∥∥Division of Dermatology, Departments of Medicine and Medical Microbiology and Immunology, University of Alberta, Edmonton, Canada; ¶¶Department of Dermatology, Stanford University, Palo Alto, CA; ##Department of Dermatology, University of Utah, Salt Lake City; ***Dermatology-Plastic Surgery Institute, Cleveland Clinic, OH; and †††Department of Medicine (Dermatology), University of Toronto, Ontario, Canada.
Address reprint requests to Peter C. Schalock, MD, Department of Dermatology, Massachusetts General Hospital, BAR622, 55 Fruit St, Boston, MA 02114. E-mail: firstname.lastname@example.org.
The authors have no funding or conflicts of interest to declare.