Q:

12/18/2013
I have a 64 year-old female with an intermittant eczematous dermatitis of 2 yrs duration. Non atopic and patch testing revealed positive reaction to gold. She is wondering if the gold fillings in her teeth could be playing any role in causing this dermatitis. The gold fillings have been present for 10 plus years. I am doubtful but would like your opinion.

A:

Thank you for your inquiry.

Unfortunately, there is no way to tell in a given patient whether or not a dermatitis is related to metal amalgam. There is, however, a body of literature that has looked at this issue, and based upon an interpretation of the data, it seems that it is possible for cutaneous contact dermatitis to occur due to metal amalgams, including gold. So the only definitive statement that we could make is that according to the literature, it is possible. Relating the significance of this literature to an individual patient of course is difficult, and in the final analysis, the decision to remove amalgams based upon this rather limited body of literature is difficult at best, and there is no definitive way to discern whether a dental amalgam is related to a systemic contact dermatitis.

For your interest, I have copied below some abstracts dealing with this issue, and there is a link also copied below to an extensive chapter on dental amalgam causing systemic contact dermatitis if you would like to read about this further.

Thank you again for your inquiry and we hope this response is helpful to you.

Allergic Contact Dermatitis to Dental Alloys: Evaluation, Diagnosis and Treatment in Japan - Reflectance Confocal Laser Microscopy, an Emerging Method to Evaluate Allergic Contact Dermatitis

Acta Derm Venereol. 2002;82(1):41-4.
Contact allergy to gold is correlated to dental gold.
Ahlgren C, Ahnlide I, Björkner B, Bruze M, Liedholm R, Möller H, Nilner K.
Author information
Department of Prosthetic Dentistry, Faculty of Odontology, Malmö University, Sweden.
Abstract
Questionnaire studies have indicated that patients with dental gold will more frequently have contact allergy to gold. This study aimed at investigating the relationship between contact allergy to gold and the presence and amount of dental gold alloys. A total of 102 patients were referred for patch testing because of suspicion of contact allergy. Patch tests were performed with gold sodium thiosulphate 2% and 5%. The patients underwent an oral clinical and radiological examination. Contact allergy to gold was recorded in 30.4% of the patients, and of these 74.2% had dental gold (p=0.009). A significant correlation was found between the amount of gold surfaces and contact allergy to gold (p=0.008), but there was no statistical relationship to oral lesions. It is concluded that there is a positive relationship between contact allergy to gold and presence and amount of dental gold alloys.

Contact Dermatitis. 2002 Aug;47(2):63-6.
Dental gold alloys and contact allergy.
Möller H.
Author information
Department of Dermatology, Malmö University Hospital, Lund University, Sweden.
Abstract
Contact allergy to gold as demonstrated by patch testing is very common among patients with eczematous disease and seems to be even more frequent among patients with complaints from the oral cavity. There is a positive correlation between gold allergy and the presence of dental gold. Gold allergy is often found in patients with non-specific stomatitides as well as in those with lichenoid reactions or with only subjective symptoms from the oral cavity. The therapeutic effect of substituting other dental materials for gold alloys is conspicuous in casuistic reports but less impressive in larger patient materials. The amount of dental gold is correlated qualitatively and quantitatively to the blood level of gold and the effects if any of circulating blood gold are unknown. There is clearly a need for prospective studies in the field and gold sodium thiosulfate is considered an important item in the dental series for patch testing.

Am J Contact Dermat. 1999 Dec;10(4):201-6.
Prevalence of gold sensitivity in asymptomatic individuals with gold dental restorations.
Schaffran RM, Storrs FJ, Schalock P.
Author information
Department of Dermatology, Oregon Health Sciences University, Portland, OR 97201, USA.
Abstract
Background: The clinical relevance of positive patch test reactions to gold sodium thiosulfate in asymptomatic individuals with gold dental restorations is often unclear. Knowledge of the prevalence of gold sensitivity in individuals with and without gold dental restorations is required to better understand the relevance of these reactions.
Objective: To determine the prevalence of positive patch test reactions to gold in asymptomatic individuals with gold dental restorations (gold patients) compared with similar individuals without gold dental appliances (nongold patients).
Methods: One hundred thirty-six healthy, asymptomatic patients were patch tested to gold sodium thiosulfate, nickel sulfate and palladium chloride. Readings occurred after 2 days and 7 days.
Results: Of the patients tested, 24 of 71 (33.8%) gold patients had a positive reaction to gold versus 7 of 65 (10.8%) of the nongold patients, P <.001. Of those with a positive gold reaction, 12 of 31 (38.7%) also had a positive nickel reaction. Nickel alone was positive in 18 of 71 (25. 4%) of gold patients versus 11 of 65 (16.9%) of nongold patients. 19 of 29 (65.5%) of those with a positive nickel reaction also reacted to palladium and 19 of 22 (86.4%) of those with a palladium reaction also reacted to nickel. The rate of allergy to gold computed over a 3-year period for patients patch tested in the Oregon Health Sciences University (OHSU) Contact Dermatitis Clinic was 13.5% (46/342).
Conclusions: The prevalence of gold sensitivity in individuals with gold dental restorations is approximately 33.8%. This is significantly greater than the 10.8% prevalence seen in individuals without gold dental appliances, as well as greater than the 3-year rate from the OHSU Contact Dermatitis Clinic. This data should help shed light on issues of clinical relevance.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology