Millions of people in the U.S. report having a metal allergy, and current estimates state that 10 percent of Americans will receive a medical implant during their lifetime1. Board-certified dermatologists attending the American Academy of Dermatology's Annual Meeting in New Orleans are seeing more patients concerned about a possible skin hypersensitivity to the nickel or other metals used in implanted medical devices.
"Metal — nickel in particular — is one of the most common culprits of allergic contact dermatitis," said board-certified dermatologist Golara Honari, MD, FAAD, a clinical associate professor of dermatology at Stanford School of Medicine. "This condition occurs when the affected skin is exposed to an allergen, often leading to patients' skin itching and followed by the development of a rash. 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."
An allergic reaction on the skin happens when the immune system recognizes an allergen upon contact and responds to it. This can result in several skin symptoms, including rash, intense itching, dryness, hives, blisters, or pain. Because everyone's immune system reacts to allergens differently, says Dr. Honari, suspected metal implant allergies can be challenging to diagnose and manage without the close collaboration between a board-certified dermatologist and the surgeon or other physician who placed the implant.
For patients who may need an implant and have a documented history of a metal allergy, Dr. Honari recommends notifying your dermatologist and informing your physician or surgeon about any allergies prior to the procedure.
"There are alternatives to metal implants," said Dr. Honari. "For example, if it's an orthopedic implant, there are ceramic options, which won't affect those who have a metal allergy. 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."
If you think the metal in your implant might be triggering a painful or problematic skin reaction, Dr. Honari recommends taking note of your symptoms and discussing them with your dermatologist and your surgeon.
"A thorough investigation is necessary to rule out more common causes of inflammation such as infection," said Dr. Honari. "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. Often, when a metal implant is put into the body, it releases some amount of metal for a certain period of time, which can cause irritation in people who have metal allergies. In many cases, this release slows down, and patients are able to keep the implant."
If the issue doesn't resolve, other options — such as removal of the implant — may be considered on a case-by-case basis. Dr. Honari says these challenging situations need to be carefully evaluated and discussed in detail among the patient, surgeon, and the dermatologist to decide whether it's worth removing and re-implanting with a device made from a different 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," said Dr. Honari. "A dermatologist can work with you and your surgeon to determine the best course of action based on your symptoms."