**4.6 Generalized eczema and pseudoatopic dermatitis**

In generalized eczema, an intractable itching dermatitis occurs on all of the skin (Fig. 7). In 1965, Shanon (Shanon, 1965) first reported pseudoatopic dermatitis to be a general eczematoid dermatitis caused by a chromic allergy due to shoe leather and cement. The clinical findings for this type of dermatitis are exactly the same as those seen for atopic

Fig. 7. Generalized eczema and pseudoatopic dermatitis.

Dental Metal Allergy 97

3. After dental treatment with metal material, skin and intraoral symptoms developed or

All of the patients were given recommendations to undergo a patch test for the purpose of diagnosing dental metal allergy. As an alternative in vitro examination, lymphocyte activation tests can also be used. However, since lymphocyte activation tests are not available for every metal element, the patch test should be considered as the first choice for

Patch testing should be done according to criteria from the International Contact Dermatitis Research Group (ICDRG). Examination plasters containing the test reagent were attached to the back or the arm of the patient for 48 hours (Groot, 2008). After waiting for one hour after the plaster removal and the effect of the stimulation was gone, changes on the skin surface were evaluated according to the ICDRG criteria (Jean-Marie Lachapelle&Maibach, 2009). The same evaluations were repeated 72 hours and one week later. Since some of the metal reagents tended to exhibit a high reaction 7 days after plaster attachment, a minimum of a one-week test period is required for these tests (Davis et al., 2008). In addition, since aluminum in the Finn Chamber reacts with Hg2+ and produces hydrochloric acid, this

The following metal reagents are the primary reagents used for a patch test (Table. 3).

**Product name Test reagent** 

Chemotechnique Diagnostics Patch Test Products, Dental Screening DS-1000

Dental materials

If patients exhibited positive reactions to any of the metal reagents of the patch test, intraoral restorations that could potentially contain metal elements should be examined. Since most of the dental metal material is an alloy metal, simply inspecting the material is not adequate for distinguishing the metal elements. Thus, a non-invasive analysis technique that extracts micro dust from the intraoral restoration and examines it with an Electron Probe Micro-Analyzer (EPMA) or an X-Ray Fluorescence Spectroscopy (XRFS) needs to be performed (Minagi et al., 1999, Suzuki, 1995, Uo&Watari, 2004). For the extraction of metal dust, a tungsten-carbide bur is sometimes used to scrape the metal restoration (Minagi et al., 1999, Suzuki, 1995). However, to ensure there were minimal invasions of the site, we employed

Dental Materials Patients DMP-1000

became incurable.

confirmation of the diagnosis.

chamber cannot be used for the HgCl2 reagent.

Trolab Patch Test Allergens Metal Compounds

Torii Patch Test Allergens Metal series

**5.3 Treatment of dental metal allergy** 

the following simple silicone point technique.

Brial Allergen GmbH Epicutaneous contact allergens

**5.2 Patch test** 

**5.2.1 Metal reagents** 

Table 3. Test reagents

dermatitis, with patients exhibiting no atopic diathesis and a low value for the immunoglobulin E (IgE) radioimmunosorbent test. Absorbed allergen is spread by blood flow and causes the eczema and urticaria on general skin, and in some cases is associated with itching, heat and painful sensations. Instead of referring to this as generalized eczema, the symptoms for this could be referred to as atopic dermatitis with metal allergy. The name of this disease is still being debated at the present time.
