[Metal implant sensitivity: clinical and histological presentation]

Area of Science:

• Orthopedics
• Dermatology
• Allergology

Background:

• Metal implant sensitivity, or intolerance, can manifest as pain, reduced mobility, implant loosening, and skin rashes.
• Accurate diagnosis relies on understanding differential diagnoses, histology, and appropriate diagnostic methods.

Purpose of the Study:

• To outline typical clinical signs and histology in metal-implant-associated skin lesions.
• To present three exemplary patients from an implant allergy outpatient department.
• To provide an overview of current literature on metal implant sensitivity.

Main Methods:

• Case study presentation of three patients with metal implant sensitivity.
• Review of current literature on metal implant sensitivity.
• Discussion of diagnostic approaches including patch testing and lymphocyte transformation testing (LTT).

Main Results:

• Even "pure" titanium alloys can contain nickel, a common allergen.
• Histological findings in implant-associated skin reactions range from teleangiectatic postimplantation erythema to eczema and vasculitis.
• Lymphocyte transformation test may detect metal sensitization in patients with negative patch tests.

Conclusions:

• Metal implant sensitivity diagnosis is improved by integrating patient history, clinical presentation, allergological testing, and histology.
• Comprehensive diagnostic strategies are crucial for precise identification of metal implant sensitivity.