Positive Patch-Test Reactions to Gold: Patients' Perception of Relevance and the Role of Titanium Dioxide in Cosmetics

Susan Nedorost; Alexis Wagman


Dermatitis. 2005;16(2):67-70. 

In This Article

Abstract and Introduction

Background: Positive patch-test reactions to gold that are without obvious clinical relevance are common. We speculate that titanium dioxide in cosmetics and sunscreens may adsorb gold particles in jewelry that occasionally contacts these areas and cause contact dermatitis on facial skin despite the absence of dermatitis under gold jewelry worn on the hands.
Objective: To identify subgroups of gold allergic patients who improve with avoidance of gold.
Methods: A questionnaire was mailed to 102 gold-allergic patients.
Results: There were 49 responses, of which all but one were from women. When asked to evaluate the statement that patch testing with gold was useful to them, one-third of respondents agreed completely, one-third agreed in part, and one-third disagreed. The majority of patients reported that their dermatitis improved after patch testing, but most were avoiding other allergens in addition to gold.
Conclusions: Avoidance of gold earrings did not appear to benefit patients with earlobe dermatitis, but total avoidance of gold jewelry on the hands and wrists did seem to benefit a subgroup of patients with facial and eyelid dermatitis who wore powder, eye shadow, or foundation on affected areas.

At the University Hospitals of Cleveland Contact Dermatitis Clinic, 15% of patients who are patch-tested have a positive response to gold. These patients rarely have rash under gold jewelry such as rings and watches, and the reaction therefore often appears irrelevant to the dermatitis under investigation.

Gold release from jewelry is encouraged by sweat or by friction or abrasive contact with hard particles. Titanium dioxide, which is used to opacify facial cosmetics and used in sunscreen as a physical blocker of ultraviolet light, is an example of a substance with such particles that is often applied to facial skin. Guin observed that contact dermatitis from gold occurs on the nasal bridge under eyeglass frames in areas of black dermatographism due to the release of small metallic particles.[1] Gold particles adhere to titanium dioxide, and the strength of the static adsorption depends on hydrogen ion concentration (pH) and other conditions.[2]

We surveyed our gold-allergic patients to determine if those who had dermatitis where they applied cosmetics or sunscreen found the avoidance of gold to be important in clearing their dermatitis.