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Practice Gaps | ONLINE FIRST

The Role of Patch Testing in the Selection and Management of Metal Device Implants
Comment on “The Effect of Patch Testing on Surgical Practices and Outcomes in Orthopedic Patients With Metal Implants”

Christen M. Mowad, MD
Arch Dermatol. 2012;148(6):693-694. doi:10.1001/archdermatol.2012.86.
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Most dermatologists are familiar with patch testing, but expanded testing beyond standard trays is not ubiquitous. Patients with metal implants (orthopedic, dental, or cardiac devices) referred to dermatologists for patch testing present a unique challenge an important practice gap. How should we manage these patients? Who benefits from testing? What, if any, impact does patch testing have on implant selection or management?

Whether seeing the patient preoperatively to determine what metals the patient is allergic to or postoperatively to help manage issues of joint failure or device complications, the dermatologist must set realistic expectations for the patient and referring physician about what information will be obtained through patch testing. For the patient undergoing testing prior to implant selection, the dermatologist must emphasize that the patch test detects current allergy but is not indicative of future allergy. In addition, limitations must be discussed. The patch test is a cutaneous test that does not recreate the environment in which the metal resides. Therefore, the testing might not recreate or elicit the same response as that of a metal within a joint space, for example. Coordinating the patch test procedure with a surgeon's timeline is yet another challenge.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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