A 10-Year Retrospective Study on Palladium Sensitivity

In This Article

Abstract and Introduction

Abstract

Background: Palladium has become an important contact allergen because of increased use in industry, jewelry, and dentistry.
Objective: To determine the frequency of palladium allergy in a US patch-test population tested to palladium.
Methods: A 10-year retrospective review (1997–2006) was performed on patients sensitive to palladium at the Department of Dermatology, Mayo Clinic, Rochester, MN.
Results: A total of 910 patients were tested to a series that included palladium chloride 2% in petrolatum. A palladium-positive patch-test result was noted in 110 patients (12.1%). Of the 106 patients sensitized to palladium who had records available for review, 15.1% had a diagnosis of lichen planus–like eruptions; 13.2%, burning mouth; 27.4%, stomatitis; and 29.2%, hand and body dermatitis.
Conclusion: Palladium sensitivity is more common in oral diseases than in skin. We describe a previously unknown high degree of co-reactivity of gold with palladium to the same degree as the known co-reactivity with nickel.

Introduction

PALLADIUM is a precious metal used in the telecommunication and automotive industries, dental alloys, and jewelry. It is in group VII of the periodic table, with platinum and nickel. In the 1980s, with the rise in gold prices, demand for palladium increased, attributed to the metal's use in the automotive industry as a catalytic converter and to the growing popularity of white gold, which contains varying amounts of palladium.^[1–3] Dental alloys may contain up to 10% palladium; white gold may contain up to 20% palladium.^[1,3] Japan is the largest consumer of palladium, followed by the United States and then Europe.^[2,4]

The frequency of palladium allergy in patch tests was reported to be 8% in Austria,^[5] 9% in mainland United Kingdom,^[6] 9% in Turkey,^[7] 5.3% in Italy,^[8] 13% in an Israeli clinic,^[9] and 2% in Northern Ireland.^[10] To our knowledge, there are no studies from the United States that report the frequency of palladium sensitivity in a patch-test population.

The primary objective of our study was to determine the frequency of palladium allergy in a US patch-test population. Our secondary objective was to determine the location and type of dermatitis and the metal co-reactants in palladium-sensitive patients.

Cite this: A 10-year Retrospective Study on Palladium Sensitivity - Medscape - Aug 01, 2009.

Table 1. Characteristics of 106 Patients* with Palladium Sensitivity
Characteristic	Overall	Palladium Relevant
Age
Mean (SD)	53.1 (14.9) yr
Range	9–82 yr
Female	98 (89.1%)	NA
Associated disease^†	106 (100.0%)	74 (69.8%)
Oral disease	59 (55.7%)	53 (50.0%)
Burning mouth syndrome	14 (13.2%)	13 (12.3%)
Lichen planus–like eruptions	16 (15.1%)	15 (14.1%)
Stomatitis	29 (27.4%)	25 (23.6%)
Skin dermatitis	31 (29.2%)	21 (19.8%)
Preventive patch testing	16 (15.1%)	0 (0.0%)

NA = not applicable.
*Four of the 110 palladium-positive patients did not have medical records available to determine correct grouping.
^†Eight patients had both oral disease and skin dermatitis.

Table 2. Metal Co-reactants in Patients with Palladium Sensitivity versus Patients without Palladium Sensitivity
Metal Sensitivity	Patients Not Sensitive to Palladium*^† (n = 800)	Patients Sensitive to Palladium*^† (n = 110)
Metal Sensitivity	Patients Not Sensitive to Palladium*^† (n = 800)	All Patients (n = 110)	Oral Disease (n = 59)	Skin Dermatitis (n = 31)	Preventive Patch Test (n = 16)
Nickel	117 (15.0)	61 (57.0)	30 (50.8)	19 (63.3)	9 (64.3)
Gold	112 (14.5)	53 (48.2)	32 (54.2)	10 (32.3)	10 (62.5)
Cobalt	84 (10.5)	41 (37.6)	15 (25.4)	17 (54.8)	7 (46.7)
Chromium	25 (3.4)	11 (10.2)	5 (8.6)	4 (13.3)	1 (6.3)
Beryllium	36 (4.8)	12 (11.0)	11 (18.6)	0 (0)	0 (0)
Mercury	82 (10.3)	18 (16.4)	13 (22.0)	3 (9.7)	2 (12.5)

*Data are reported as numbers and percentages (in parentheses).
^†Percentages are based on the number of patients who were patch-tested with both allergens.

Table 3. Characteristics and Metal Allergies of Palladium-Sensitive Patients with Oral Disease
Characteristic	Patients with Oral Disease
Characteristic	Burning Mouth Syndrome (n = 14)	Lichen Planus–Like Eruption (n = 16)	Stomatitis (n = 29)
Age, mean (range)	58.6 (33–82) yr	60.0 (43–69) yr	55.0 (33–79) yr
Female sex	14 (100.0%)	15 (93.8%)	25 (86.2%)
Metal sensitivity
Gold	6 (42.9%)	11 (68.8%)	15 (51.7%)
Nickel	8 (57.1%)	6 (37.5%)	16 (55.2%)
Cobalt	5 (35.7%)	1 (6.3%)	9 (31.0%)
Chromium	1 (7.1%)	2 (12.5%)	2 (6.9%)
Beryllium	2 (14.3%)	2 (12.5%)	7 (24.1%)
Mercury	2 (14.3%)	5 (31.3%)	6 (20.7%)
Sensitivity to flavoring agents*	7 (50.0%)	10 (62.5%)	3 (10.3%)

*Balsam of Peru (n = 7), cinnamic aldehyde (n = 1), benzoic acid (n = 5), benzoyl alcohol or peroxide (n = 3), and fragrance (n = 3).

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A 10-year Retrospective Study on Palladium Sensitivity

Abstract and Introduction

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