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Granuloma possibly induced by palladium after ear piercing
Leen Thijs1, Karen Deraedt, An Goossens
1Department of Dermatology, University Hospital, K.U. Leuven, Belgium.
Dermatitis : Contact, Atopic, Occupational, Drug
|October 11, 2008
Summary
A patient developed persistent, granulomatous skin lesions on their earlobe after piercing, diagnosed as allergic contact granuloma from palladium. Patch testing confirmed palladium allergy, highlighting a rare cause of granulomatous reactions to metals.
Area of Science:
- Dermatology
- Allergology
- Pathology
Background:
- Allergic contact dermatitis can manifest in various forms, including granulomatous reactions.
- Metal allergies are a known cause of delayed hypersensitivity reactions.
- Sarcoidal-type reactions are granulomatous inflammatory responses that can be triggered by diverse stimuli.
Observation:
- A patient presented with papulonodular lesions on the earlobe following ear piercing, evolving over 3-4 years into treatment-resistant granulomatous nodules.
- Intralesional corticosteroid injections provided only temporary symptom relief.
- Patch testing revealed a strong positive reaction to palladium and nickel.
Findings:
- Biopsy of the earlobe lesion and palladium test site showed epithelioid granulomas with multinucleate histiocytes and a lymphocytic-histiocytic infiltrate.
- Histopathology confirmed a sarcoidal-type allergic contact granuloma.
- The findings indicate palladium as the causative agent for the granulomatous reaction.
Implications:
- This case highlights palladium as a potential allergen causing persistent granulomatous skin reactions, particularly in response to body piercings.
- Accurate diagnosis requires thorough history, patch testing for metals, and histopathological examination.
- Awareness of metal-induced granulomas is crucial for effective patient management and prevention of treatment-resistant lesions.
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