Contact dermatitis to metals

Metals are in close contact with skin and mucous membranes on a repeated, if not constant, basis. Nickel and mercury, well-recognized causes of contact dermatitis; gold and palladium, recently gaining acceptance as patch test allergens on standard screening trays; and cobalt are reviewed in this article. Sensitization to nickel, the most frequently identified allergen on patch testing, is associated with ear piercing. Contact with this potential allergen is ubiquitous. Mercury may be encountered as organic mercury in thimerosal, used as an antiseptic and a preservative in topical medications and vaccines, and metallic mercury found in dental amalgam and thermometers. Both forms may cause contact dermatitis. Gold, recognized as a frequent sensitizer, has been implicated in some cases of eyelid, patchy diffuse and oral lichenoid dermatitis. Cobalt allergy, found frequently in patients who are nickel allergic, also has been associated with ear piercing. Palladium sensitivity is often associated with nickel allergy. However, the incidence of clinical relevance is yet to be established.