Patch Testing With Nickel, Cobalt, and Chromium in Patients With Suspected Allergic Contact Dermatitis

Jonathan I. Silverberg, From the Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia, USA.
Nisha Patel, From the Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia, USA.
Erin M. Warshaw, Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.
Joel G. DeKoven, Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Donald V. Belsito, Department of Dermatology, Columbia University Irving Medical Center, New York, New York, USA.
Amber R. Atwater, Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA.
James S. Taylor, Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.
Denis Sasseville, Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Canada.
Margo J. Reeder, Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Marie-Claude Houle, Division of Dermatology, Centre Hospitalier Universitaire (CHU) de Québec, Laval University, Quebec, Canada.
Vincent A. DeLeo, Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Howard I. Maibach, Department of Dermatology, University of California San Francisco, San Francisco, California, USA.
Joseph F. Fowler, Division of Dermatology, University of Louisville, Louisville, Kentucky, USA.
Kathryn A. Zug, Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Melanie D. Pratt, Division of Dermatology, University of Ottawa, Ottawa, Canada.
JiaDe Yu, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Christen M. Mowad, Division of Dermatology, Geisinger Health System, Danville, Pennsylvania, USA; and.
Nina C. Botto, Department of Dermatology, University of California San Francisco, San Francisco, California, USA.
Brandon L. Adler, Department of Dermatology, University of Southern California, Lost Angeles, California, USA.

Document Type

Journal Article

Publication Date

12-4-2023

Journal

Dermatitis : contact, atopic, occupational, drug

DOI

10.1089/derm.2023.0139

Abstract

Allergic contact dermatitis is frequently caused by metals, including multiple metals simultaneously. To assess characteristics and associations of positive and clinically relevant patch test (PT) reactions with solitary and concurrent metal sensitization. A retrospective analysis of PT results for nickel, cobalt, and/or chromium from the North American Contact Dermatitis Group between 2001 and 2018 ( = 43,522). 18.0% had a positive/allergic reaction to nickel sulfate hexahydrate, 7.3% to cobalt chloride hexahydrate, and 3.0% to potassium dichromate. 87.9% patients had a currently relevant reaction to 0, 9.4% to 1, and 2.7% to multiple metals tested. Patients with 1 versus no currently relevant reactions to metal were more likely to have a primary dermatitis site of trunk, feet, and ears; patients with currently relevant reactions to multiple metals had more dermatitis affecting the trunk and ears. Metal sources varied by co-reacting metal, especially for patients with cobalt and chromium allergy. Jewelry was the most commonly identified source of nickel and cobalt for both solitary and concurrent metal allergy. Sensitization to multiple metals occurred in 6% of patients. Allergen sources varied between patients with sensitivity to 1 metal versus those who had concurrent sensitivity to cobalt and/or chromium.

Department

Dermatology

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