title: Patch testers' opinions regarding diagnostic criteria for metal hypersensitivity reactions to metallic implants.
abstract: BACKGROUND
  Metal hypersensitivity reactions to implanted devices remain a challenging and controversial topic. Diagnostic criteria and methods are not well delineated.
  
  
  OBJECTIVE
  Diagnostic criteria for hypersensitivity reactions after metallic device implantation are evaluated in this study by a multinational group of patch testers using Thyssen's previously published criteria.
  
  
  METHODS
  A total of 119 dermatologists at the 2012 European Contact Dermatitis Society and 2013 American Contact Dermatitis Society meetings answered a survey regarding their opinions on topics relating to metal hypersensitivity.
  
  
  CONCLUSIONS
  Four major and 5 minor diagnostic criteria emerged. Approximately 80% of respondents found the following criteria useful (major criteria): chronic dermatitis beginning weeks to months after metallic implantation, eruption overlying the metal implant, positive patch test to a metal component of the implant, and complete clearing after removal of the potentially allergenic implant. Minor criteria (<61% of respondents) were as follows: systemic allergic dermatitis reaction, therapy-resistant dermatitis, morphology consistent with dermatitis, histology consistent with allergic contact dermatitis, and a positive in vitro test to metals (eg, lymphocyte transformation test). In the challenging situation such as a symptomatic or failing orthopedic device, applying these 4 major criteria and the 5 supportive minor criteria may be useful for guiding decision making.
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA 02114, USA. schalock.prof@gmail.com
authors.forename: Peter C
authors.initials: PC
authors.lastname: Schalock
authors.forename: Jacob P
authors.initials: JP
authors.lastname: Thyssen
mesh_terms: D003880:Dermatology / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D008670:Metals / Q000009:adverse effects*; D010328:Patch Tests; D011159:Population Surveillance; D019736:Prostheses and Implants / Q000009:adverse effects*
chemical_list: D008670:Metals