We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
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.
Text Size: A A A
Published online


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.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
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.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

1 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections