Clinicians faced with baffling contact dermatitis patients should expand their view of potential causes to include metals anywhere in the body, according to Jennifer H. Perryman, MD, of the Greeley Skin Clinic in Fort Collins, Colo.

For example, metal from orthopedic implants can cause contact dermatitis, Dr. Perryman said at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

The cutaneous complications of metal implants generally are eczematous, but they can be urticarial and vasculitic as well, with symptoms either generalized or localized. Dr. Perryman explained. Noncutaneous complications from contact dermatitis associated with the metal include chronic joint pain, and a loosening and dysfunction of the device.

It is a case of “chicken or the egg: Metal allergy causes device failure, or device failure causes metal allergy,” Dr. Perryman said.

Dental implants also can be unforeseen causes of contact dermatitis, she noted. The bone cement used in some implants may contain a variety of potential irritants such as methyl methacrylate, N,N-dimethyl-p-toluidine (DPT), benzoyl peroxide, gentamicin, and hydroquinone.

Metal allergy in the mouth most often presents as a reaction resembling oral lichen planus, with lesions that are reticular, atrophic, erosive, or plaque-like. These lesions usually erupt next to the implant, she said. Some patients also experience burning mouth syndrome from amalgam tattoos. However, some patients who test positive for metal allergies in general have developed a tolerance for dental implants as a result of having worn braces in the past.

Metal eyelid weights implanted to treat lagophthalmos are another rare, but potential allergen to consider, said Dr. Perryman. These weights often are made of gold, and Dr. Perryman cited a study in which four patients with gold eyelid weights experienced inflammatory reactions. Patch testing revealed gold sodium thiosulfate as the cause of their allergic contact dermatitis (Dermatitis. 2008 May-Jun;19[3]:148-53). Other options for these patients include platinum weights, hyaluronic acid, ointment, and taping, she said.

Dr. Perryman had no financial conflicts to disclose. SDEF and this news organization are owned by Frontline Medical Communications.