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Updated: May 2, 2026

In Situ Detection and Single Cell Quantification of Metal Oxide Nanoparticles Using Nuclear Microprobe Analysis
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Titanium: An Unusual Allergen With Various Presentations-A Retrospective Cohort Study.

Danny Daniely1,2, Valentina Zemser-Werner1,2, Roy Gilon-Omer1,2

  • 1Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

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|August 26, 2025
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Summary
This summary is machine-generated.

Titanium sensitization can cause dermatitis, especially from jewelry and implants. Further investigation into titanium-induced Bullous pemphigoid (BP) is warranted due to its emerging prevalence.

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Area of Science:

  • Allergy and Immunology
  • Dermatology
  • Toxicology

Background:

  • Titanium (Ti) is a metal with a unique exposure profile, often overlooked as an allergen.
  • Evaluation of titanium sensitization is crucial in specific clinical contexts due to increasing exposure.
  • Understanding titanium's role in allergic reactions is essential for accurate diagnosis and management.

Purpose of the Study:

  • To characterize the clinical features of patients experiencing titanium sensitization.
  • To identify common exposure sources and clinical presentations associated with titanium allergy.
  • To assess the diagnostic utility of metal series patch testing in suspected titanium sensitivity.

Main Methods:

  • Retrospective cohort analysis of 255 patients patch tested with a metal series.
  • Inclusion of patients tested between 2012 and 2024 at a tertiary contact dermatitis clinic.
  • Evaluation of clinical characteristics and sensitization patterns, including titanium oxalate reactions.

Main Results:

  • Positive titanium oxalate reactions occurred in 5% of cases, frequently linked to jewelry (38%).
  • Dermatitis from titanium typically presented adjacent to the contact site, primarily on hands and fingers.
  • Significant percentages of patients with tattoo-induced dermatitis (100%) and post-orthopaedic implant reactions (67%) would have been missed without the metal series.
  • Two cases associated with medical implants developed generalized rash, one with Bullous pemphigoid (BP).

Conclusions:

  • Titanium sensitization may become more prevalent due to medical devices, implants, and recreational exposures like 'nickel-free' jewelry and tattoos.
  • Titanium-induced Bullous pemphigoid (BP) is a notable phenomenon requiring further investigation at the intersection of allergology and immunology.
  • Metal series patch testing is vital for diagnosing allergies to less common metals like titanium, especially in cases involving implants and tattoos.