{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:50:37Z","timestamp":1790171437231,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,8,9]],"date-time":"2017-08-09T00:00:00Z","timestamp":1502236800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"intramural research project","award":["SFP 1322-604"],"award-info":[{"award-number":["SFP 1322-604"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Contact Dermatitis"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Allergic reactions to tattoos are not uncommon. However, identification of the culprit allergen(s) remains challenging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We present a patient with papulo\u2010nodular infiltration of 20\u2010year\u2010old tattoos associated with systemic symptoms that disappeared within a week after surgical removal of metal osteosynthesis implants from his spine. We aimed to explore the causal relationship between the metal implants and the patient's clinical presentation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Metal implants and a skin biopsy of a reactive tattoo were analysed for elemental contents by inductively coupled plasma mass spectrometry and synchrotron\u2010based <jats:styled-content style=\"fixed-case\">X<\/jats:styled-content>\u2010ray fluorescence (<jats:styled-content style=\"fixed-case\">XRF<\/jats:styled-content>) spectroscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nickel (<jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>i) and chromium (<jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>r) as well as high levels of titanium (<jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>i) and aluminium were detected in both the skin biopsy and the implants. <jats:styled-content style=\"fixed-case\">XRF<\/jats:styled-content> analyses identified <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>r(<jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>), with <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>r(<jats:styled-content style=\"fixed-case\">VI<\/jats:styled-content>) being absent. Patch testing gave negative results for <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>i and <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>r. However, patch tests with an extract of the implants and metallic <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>i on the tattooed skin evoked flare\u2010up of the symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The patient's hypersensitivity reaction and its spontaneous remission after removal of the implants indicate that <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>i, possibly along with some of the other metals detected, could have played a major role in this particular case of tattoo\u2010related allergy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cod.12862","type":"journal-article","created":{"date-parts":[[2017,8,10]],"date-time":"2017-08-10T04:58:35Z","timestamp":1502341115000},"page":"397-405","source":"Crossref","is-referenced-by-count":35,"title":["Are metals involved in tattoo\u2010related hypersensitivity reactions? A case report"],"prefix":"10.1111","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5084-7846","authenticated-orcid":false,"given":"Christa","family":"de Cuyper","sequence":"first","affiliation":[{"name":"Department of Dermatology, AZ Sint\u2010Jan Brugge\u2010Oostende AV  8000 Brugge Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyne","family":"Lodewick","sequence":"additional","affiliation":[{"name":"Department of Dermatology, ZorgSaam Zeeuws\u2010Vlaanderen  4535 PA Terneuzen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9313-7193","authenticated-orcid":false,"given":"Ines","family":"Schreiver","sequence":"additional","affiliation":[{"name":"Department of Chemical and Product Safety German Federal Institute for Risk Assessment (BfR)  10589 Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Hesse","sequence":"additional","affiliation":[{"name":"European Synchrotron Radiation Facility (ESRF)  38043 Grenoble Cedex 9 France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Seim","sequence":"additional","affiliation":[{"name":"Physikalisch\u2010Technische Bundesanstalt  10587 Berlin Germany"},{"name":"Technische Universit\u00e4t Berlin, Institut f\u00fcr Optik und Atomare Physik  10623 Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiram","family":"Castillo\u2010Michel","sequence":"additional","affiliation":[{"name":"European Synchrotron Radiation Facility (ESRF)  38043 Grenoble Cedex 9 France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Laux","sequence":"additional","affiliation":[{"name":"Department of Chemical and Product Safety German Federal Institute for Risk Assessment (BfR)  10589 Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Luch","sequence":"additional","affiliation":[{"name":"Department of Chemical and Product Safety German Federal Institute for Risk Assessment (BfR)  10589 Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,8,9]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60215-X"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000369645"},{"key":"e_1_2_7_4_1","first-page":"29","volume-title":"Dermatologic Complications with Body Art. 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