Criteria for the diagnosis of hypersensitivity to implanted metals

Major criteria

Eruption overlying the metal implant

Positive patch test reaction to a metal used in the implant

Complete recovery following removal of the offending implant

Chronic dermatitis beginning weeks to months after metallic implantation

Minor criteria

Dermatitis reaction is therapy resistant

Morphology consistent with dermatitis (erythema, induration, papules, vesicles)

Systemic allergic dermatitis reaction

Histology consistent with allergic contact dermatitis

Positive in vitro test to metals, eg, the lymphocyte transformation test

References:

Thyssen JP, Menné T, Schalock PC, et al. Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery. Br J Dermatol 2011; 164:473.
Schalock PC, Menné T, Johansen JD, et al. Hypersensitivity reactions to metallic implants - diagnostic algorithm and suggested patch test series for clinical use. Contact Dermatitis 2012; 66:4.
Schalock PC, Thyssen JP. Patch testers' opinions regarding diagnostic criteria for metal hypersensitivity reactions to metallic implants. Dermatitis 2013; 24:183.

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