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March 5, 1973

Nickel Dermatitis Hazards From Prostheses

JAMA. 1973;223(10):1159. doi:10.1001/jama.1973.03220100053023

To the Editor.—  Two letters relating to this subject were published recently in The Journal.1,2 The following comments are pertinent to this problem.Barranco and Soloman1 reported a case of eczematous dermatitis from internal exposure to nickel from a stainless steel screw in the patella. (Nickel sensitivity was demonstrated by patch testing: pure nickel, 3% nickel sulfate, and pieces of the stainless steel screw gave positive results; test results were negative with metallic salts such as potassium dichromate, cobalt sulfate, and mercuric chloride.) The stainless steel contained 14% nickel. Following removal of the screws, the dermatitis subsided within 72 hours. This would imply that nickel released from the stainless steel screws (a tenable thesis because Ferguson and co-workers3 and Mears4 have reported increased nickel concentrations in parenchymal tissues from implantation of stainless steel rods containing nickel) produced the allergic reaction. Fisher, on the other hand, rejected