A 10-year Retrospective Study on Palladium Sensitivity

Olayemi Durosaro; Rokea A. el-Azhary

Disclosures

Dermatitis. 2009;20(4):208-213. 

In This Article

Results

A patch-test result positive for palladium chloride 2% was noted in 110 (12.1%) of the 910 patients. Among these patients, a weak reaction to palladium was noted in 34 patients (30.9%), a strong reaction in 50 (45.5%), and an extreme reaction in 26 (23.6%).

Of the 110 patients who were sensitive to palladium, only 106 had patient records available for review. Four patients were referred to our institution for patch testing only. Table 1 summarizes the characteristics of 106 palladium-sensitive patients. The ages ranged from 9 to 82 years; the mean age was 53.1 years. There were 98 female patients and 8 male patients. Statistical analysis showed that patients with palladium sensitivity were more likely to be female (OR, 3.5; 95% CI, 1.9–6.5; p < .001). Specifically, 98 (89.1%) of all palladium-sensitive patients were female, compared with 559 (69.9%) of the 800 (ie, 910 − 110) patients who were not palladium-sensitive. Sixteen patients (15.1%) had no skin manifestations but received patch testing for detection of metal allergy before surgical implantation of a metal prosthesis, referred to herein as a "preventive" patch test.

Most (55.7%) of the patients sensitized to palladium had oral disease diagnosed as lichen planus or lichenoid tissue reaction, stomatitis, or burning mouth, as compared with 31 patients (29.2%) with skin involvement diagnosed as dermatitis. Of the latter 31 patients, 17 were allergic to metal jewelry (mostly watches, earrings, and necklaces) and 4 were allergic to the frame of their eyeglasses.

The majority (101 [91.8%]) of the 110 patients were sensitive to more than one metal. Among the 110 patients, 9 (8.2%) had one positive reaction (to palladium only), 9 (8.2%) had two positive reactions, and 92 (83.6%) had three or more positive reactions. Of the 110 patients who were sensitized to palladium, 107 were also tested with nickel and cobalt; 61 (57.0%) of these 107 patients were sensitized to both palladium and nickel, and 33 (30.8%) were sensitized to palladium, nickel, and cobalt. Statistical analysis showed that patients with palladium sensitivity were more likely to have a nickel sensitivity (OR, 7.5; 95% CI, 4.9–11.6; p < .001). Specifically, 61 (57.0%) of the 107 palladium-sensitive patients who were also tested with nickel had a reaction to nickel, compared with 117 (15.0%) nickel-sensitive patients who did not have a palladium sensitivity. Patients with palladium sensitivity were more likely to be sensitized to gold than were patients without palladium sensitivity (OR, 5.5; 95% CI, 3.6–8.4; p <. 001). In particular, 53 (48.2%) of the palladium-sensitive patients had a gold reaction, compared with 112 (14.5%) gold-sensitive patients who did not have a palladium reaction.

Nine (8.2%) patients were sensitized to palladium metal only. Of these patients, 4 had preventive patches, 2 had stomatitis, and the other 3 patients had lichen planus, burning mouth, and dermatitis, respectively. Sensitization to flavoring agents as nonmetal allergens was noted for the patient with lichen planus, and sensitization to flavoring agents plus colophony and phenol-formaldehyde resin was noted for the patient with dermatitis.

Table 2 summarizes the metal co-reactants of the palladium-sensitive patients. Sixty-one (57.0%) of the 107 patients who were tested with both palladium and nickel (9 of whom were in the preventive-patch group) were sensitized to nickel. Thirty (50.8%) of 59 patients with oral disease were sensitized to nickel, compared with 19 patients (63.3%) in the group with skin dermatitis. Gold was the second most frequent co-reactant in all groups, its incidence ranking almost as high as that of nickel. In patients with oral disease, this incidence was as high as 54.2%, which was slightly higher than the incidence for nickel (50.8%). In patients with skin dermatitis, gold co-reactivity was considerably less than that of nickel (32.3% vs 63.3%). In all patients, beryllium was almost as common as mercury in its frequency as a co-reactant. No patient with skin involvement had co-reactivity to beryllium, as compared to an 18.6% incidence of co-reactivity in patients with oral disease. Table 3 shows the breakdown of metal co-reactants within the three categories of oral disease. Gold showed the highest frequency as a co-reactant in patients with lichen planus and stomatitis—as high as 68.8% and 51.7%—when compared to patients with burning mouth syndrome (BMS) (42.9%).

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