Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Case Report
2010:76:4;397-399
doi: 10.4103/0378-6323.66594
PMID: 20657122

Persistent nodular contact dermatitis to gold: Case report of two cases

Vandana Mehta, C Balachandran
 Department of Skin and STD, Kasturba Hospital, Manipal - 576 104, Karnataka, India

Correspondence Address:
Vandana Mehta
Department of Skin and STD, Kasturba Hospital, Manipal - 576 104, Karnataka
India
How to cite this article:
Mehta V, Balachandran C. Persistent nodular contact dermatitis to gold: Case report of two cases. Indian J Dermatol Venereol Leprol 2010;76:397-399
Copyright: (C)2010 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

Metallic gold has long been regarded as a relatively safe and inert material when in contact with the skin and mucosal membranes, with only sporadic reports of allergic contact dermatitis. We report two cases, where persistent nodules developed at sites of gold piercing with gold jewelry with positive patch test reactions to gold.
Keywords: Gold, persistent nodular contact dermatitis, patch test

Introduction

0Metallic gold has long been regarded as a relatively safe and inert material when in contact with the skin and mucosal membranes with only sporadic reports of allergic contact dermatitis or stomatitis. [1],[2],[3],[4],[5] This is probably due to its stability with low tendency to ionization. We report two cases where persistent nodules developed at sites of gold piercing with positive patch test reactions to gold.

Case Reports

Case 1

A 24-year-old nursing student presented with an asymptomatic skin colored nodule on her nose of 10-year duration [Figure - 1]. Before ten years, she had her nose pierced with a 22 carat gold nose ring, following which she developed a nodule over the pierced site. There was neither any history of previous dental procedures using gold alloys nor of dermatitis on contact with jewelry at other body sites. Considering the lesion to be a simple keloid following nose piercing, a surgical excision of nodule was done on two occasions before she presented to us, but every time the nodule recurred following nose piecing with gold. An excision biopsy of the nodule demonstrated numerous granulomas in the dermis composed of foreign body giant cells with refractive material within them, lymphocytes and epitheloid cells [Figure - 2] and [Figure - 3]. Patch testing was performed with Indian standard series containing nickel, chromium, cobalt in addition to the standard battery of other antigens and 1% gold sodium thio-sulfate applied in petrolatum as a standard patch demonstrated a 2+ reaction to gold sodium thio-sulfate at 48 and 72 hours [Figure - 4]. She was advised application of potent topical steroids to prevent recurrence of the lesions.

Case 2

A 21-year-old female presented with asymptomatic reddish nodules at the site of ear piercing with 18 carat gold earrings of three-month duration. Approximately one month after ear piercing, she developed pain, swelling and tenderness of the affected sites which subsided with a course of antibiotics and topical steroids. Despite removing her earrings and avoiding further contact with gold, she developed persistent nodules at each pierced site, which have remained unchanged since then. There was no history of any previous allergy to metals or atopy. Patch test with Indian standard series which contained nickel, chromium, cobalt and 1% gold sodium thio-sulfate in petrolatum applied as a standard patch revealed a 2+ reaction to gold sodium thio-sulfate at 48 and 72 hours. She was apprehensive about the surgical procedures and refused to undergo a biopsy of the nodules.

Discussion

Gold allergy was traditionally regarded as a rare occurrence, however, the new fashion of piercing multiple body sites in youngsters have triggered frequent reports of contact dermatitis to gold. A female predominance with involvement of the head and neck region, particularly in a seborrheic distribution, has been reported frequently in previous studies. [1]

Gold contact allergy may present clinically as a chronic papular eruption characterized by minimal eczematous changes, but with prominent dermal involvement. This presentation has been observed in gold sensitive individuals who have worn pierced type gold earrings; in whom discrete nodules have developed at the site of piercing, which have remained despite avoidance of further gold contact. [2],[3] For insoluble and inert gold to induce dermatitis, small amounts of it need to be converted to a soluble form by the action of amino acids in sweat which is subsequently absorbed into the skin. [4] Hence, contact between skin and gold jewelry or between gold and the oral mucosa are the most important sources of sensitization. Ear or nose piercing with gold allows direct contact between gold and the dermis and is also associated with a trauma related inflammatory response. Both may facilitate the development of hypersensitivity. [5] Histologically, these nodules show minimal epidermal change and a dense dermal lymphocytic infiltration often associated with lymphoid follicles. Individuals with such lymphocytoma cutis type lesions frequently display strong positive patch test reaction to gold salts.

Both our patients developed nodules at the sites of ear and nose piercing with 18 and 22 carat gold jewelry which persisted despite avoidance of gold. Further biopsy of our first patient displayed a granulomatous reaction with presence of refractive material within the giant cells. The composition of the refractile material in our case could not be found out because we did not have facilities for the same at our centre, however, the presence of a positive patch test reaction to gold with a negative reaction to nickel and other metals more or less confirmed our diagnosis of gold allergy. Gold incorporated in the dermis via piercing is difficult to eliminate, causing the antigen to remain at the local site for long. Its persistence within the macrophages explains the ongoing immunological activation and the resultant granulomatous reaction. [6] When gold penetrates via the epidermis an eczematous allergic contact reaction ensues which explains the eczematous nature of the patch test reaction. This indicates that the cellular response in the dermis with continuous antigen exposure is distinct from that characterized by contact sensitivity in the epidermis. [3]

On the basis of clinical, histopathological and patch test findings in our cases, we postulate that the persistent nodules at the site of piercing were simply an expression of contact dermatitis to gold. Hence, any patient with presence of nodules at the site of ear, nose, belly button piercing should be patch tested; if necessary the lesions be biopsied to confirm the diagnosis of contact allergy.

References
1.
McKenna KE, Dolan O, Walsh MY, Burrows D. Contact allergy to gold sodium thiosulfate. Contact Dermatitis 1995;32:143-6.
[Google Scholar]
2.
Kobayashi Y, Nanko H, Nakamura J, Mizoguchi M. Lymphocytoma cutis induced by gold pierced earrings. J Am Acad Dermatol 1992;27;457-8.
[Google Scholar]
3.
Conde-Taboada A, Rosσn E, Fernαndez-Redondo V, Garcνa-Doval I, De La Torre C, Cruces M. Lymphomatoid contact dermatitis induced by gold earrings. Contact Dermatitis 2007;56:179-81.
[Google Scholar]
4.
Brown DH, Smith WE, Fox P, Sturrock RD. The reactions of gold with amino acids and the significance of these reactions in the biochemistry of gold. Inorganic Chim Acta 1982;67:23-30.
[Google Scholar]
5.
Armstrong DK, Walsh MY, Dawson JF. Granulomatous contact dermatitis due to gold earrings. Br J Dermatol 1997;136:776-8.
[Google Scholar]
6.
Uruhata O, Kase K. Dermatitis due to pierced earrings. Jpn J Pract Dermatol 1999;20:711-4.
[Google Scholar]

Fulltext Views
298

PDF downloads
151
Show Sections