Many patients worry that receiving a metal implant might set off their metal allergy, according to the American Academy of Dermatology.
"Cases in which patients are inquiring about a metal allergy as it relates to their metal implants -- including joint replacements, rods, pins, screws, plates, certain neurologic and cardiac devices such as pacemakers, and dental devices -- are becoming more prevalent as medical implants become more common,” said Dr. Golara Honari, a clinical associate professor of dermatology at Stanford School of Medicine.
About 10% of Americans will receive a medical implant during their lifetime. Millions of people in the United States report having a metal allergy.
Metal, especially nickel, is one of the most common causes of allergic contact dermatitis, Honari said. It develops when skin is exposed to an allergen, often leading to a rash and itching. Other symptoms can include dryness, hives, blisters or pain.
Honari noted that suspected metal implant allergies can be difficult to diagnose because everyone's immune system reacts to allergens differently.
Close collaboration between a dermatologist and the surgeon or physician who placed the implant is essential, she said.
Patients who need an implant and have a documented history of a metal allergy should notify their dermatologist and physician or surgeon about any allergies prior to the procedure.
Alternatives to metal implants are available.
“For example, if it's an orthopedic implant, there are ceramic options, which won't affect those who have a metal allergy," Honari said in an academy news release. "There must be a very close relationship between the surgeon and dermatologist as they work together to consider if a patient needs a different type of implant or if they should be tested for metal allergies prior to surgery," she said.
Patients who think they might be having a painful or problematic skin reaction triggered by a metal implant should take note of their symptoms and talk to their dermatologist or surgeon about them.
“A thorough investigation is necessary to rule out more common causes of inflammation such as infection," Honari said. “However, if an allergic reaction is suspected, the first line of treatment may be topical and/or oral medications, like anti-inflammatories, which can relieve pain, reduce inflammation and bring down a high temperature.”
When it is put into the body, a metal implant often releases some metal for a period of time, she pointed out. This can cause irritation in patients with metal allergies, but this may be temporary.
“In many cases, this release slows down, and patients are able to keep the implant,” Honari said.
Removal of the implant may be considered on a case-by-case basis. Surgeon, dermatologist and patient will evaluate whether it should be replaced with a device made from another material.
“If you have an allergy to metal and will be getting an implant, or if you suspect your medical implant is causing an allergic reaction, consult your surgeon and a board-certified dermatologist for an evaluation,” Honari said. “A dermatologist can work with you and your surgeon to determine the best course of action based on your symptoms.”
The U.S. Geological Survey has more on metals and minerals in implants.
SOURCE: American Academy of Dermatology, news release, March 17, 2023