Cutaneous and Systemic Hypersensitivity Reactions to Metallic Implants

Juliana L. Basko-Plluska; Jacob P. Thyssen; Peter C. Schalock


Dermatitis. 2011;22(2):65-79. 

In This Article

Compositions of Metal Implants

Most orthopedic dental implants, intracoronary stents, prosthetic valves, endovascular prostheses and some gynecologic devices are made from metal alloys (Table 1). Orthopedic implants are most often made from steel (stainless or cobalt-chromium alloys), vitallium, or titanium.[7–10] A newer metal, oxidized zirconium (Oxinium, Smith & Nephew, San Antonio, TX), is also available and is primarily used in knee prostheses. Metals used in metallic dental implants include mercury amalgam (an alloy of mercury with tin, silver, zinc, or copper), gold alloys, chromium-based alloys, stainless steel, palladium, titanium, and cobalt alloys.[11] Endovascular devices (metal stents, abdominal aortic aneurysm endografts, and patent foramen ovale occluders) are frequently manufactured from metal alloys such as stainless steel and nitinol.[12] Cardiac pacemakers are often made of titanium; hence, titanium is the most common allergen to elicit pacemaker-induced dermatitis.[13] As expected, metal ions are the most frequent causative allergens in allergic cutaneous dermatitis associated with all the aforementioned devices. The components of these materials are summarized in Table 2.[8,10,14,15]


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