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January 15, 1973

Reactions to Nickel

JAMA. 1973;223(3):326-327. doi:10.1001/jama.1973.03220030060025

To the Editor.—  Recent letters by Fisher and Kellum, "Safety of Stainless Steel in Nickel Sensitivity" (221:1279, 1972) in response to our article "Eczematous Dermatitis From Nickel," (220:1244, 1972) seem to cast some doubt on the ability of nickel in stainless steel surgical implants to cause "internal" allergic contact dermatitis.Fisher states that positive results of patch tests to a hard metal like stainless steel may represent only an irritant reaction. As stated in our article, the patient also had a positive result in a patch test for chemical nickel in petrolatum. Fisher also apparently ignored that this patient's unrelenting dermatitis cleared completely and promptly only when the stainless steel screws were removed.He further states that he had never heard of allergic reactions to stainless steel. One of the references in our article1 presented two documented cases of widespread eczematous dermatitis from internal exposure to nickel in stainless steel