{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:40:09Z","timestamp":1790361609079,"version":"4.1.0"},"reference-count":71,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Dermatitis\u00ae"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Metal allergens remain major causes of allergic contact dermatitis (ACD) worldwide. In Turkey, restrictions on nickel release (2018) and hexavalent chromium in leather (2018) and cement (2022) have been implemented, but their impact remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To assess long-term metal sensitization patterns and evaluate occupational\/nonoccupational metal-related ACD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively analyzed 2932 patients patch-tested with nickel sulfate 5% pet., cobalt chloride 1% pet., potassium dichromate 0.5% pet., and palladium chloride 1\u20132% pet. (1996\u20132021). Multivariate logistic regression identified independent predictors of sensitization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The overall prevalence of sensitization to baseline metals was 28.4%. Nickel was the most frequent sensitizer (21.1%), followed by chromium and palladium (both 8.9%), and cobalt (7.1%). Current clinical relevance was highest for chromium (67.4%) and cobalt (51.2%). Occupational ACD (47.5%) was mainly related to chromium\/cobalt exposure from cement and metal tools, predominantly affecting the hands, with a notable airborne involvement. Chromium sensitization declined over time. Nickel predominated in nonoccupational ACD and dietary nickel-related systemic allergic dermatitis (SAD) (4.8%), with frequent palladium\u2013nickel cosensitization. Metal device\/implant allergy was rare (3.5%). Multivariate analysis identified female sex and younger age as predictors of nickel sensitization, whereas male sex and occupational exposure predicted chromium sensitization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Metal sensitization remains highly prevalent in Turkey, particularly nickel sensitization. The decline in chromium sensitization likely reflects changes in construction practices. The association between nickel sensitization and SAD highlights the importance of systemic exposure in clinical management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17103568261450838","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:07:46Z","timestamp":1780639666000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Nickel Persists, Chromium Declines: A 26-Year Perspective on Metal Sensitization and Clinical Relevance from Turkey"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1656-6290","authenticated-orcid":false,"given":"Muhammed Burak","family":"G\u00fcnay","sequence":"first","affiliation":[{"name":"Department of Dermatology and Venereology, \u0130stanbul Faculty of Medicine, \u0130stanbul University \u0130stanbul, Turkey"},{"name":"Department of Dermatology, Danderyd Hospital, Stockholm, Sweden."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esen","family":"\u00d6zkaya","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, \u0130stanbul Faculty of Medicine, \u0130stanbul University \u0130stanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13119"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.14167"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.14170"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/derm.2024.0474"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.2008.01468.x"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.5114\/ada.2017.67843"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13653"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.2011.01878.x"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12295"},{"key":"e_1_3_1_11_2","first-page":"1","article-title":"Directive 94\/27\/EC of 30 June 1994 amending for the 12th time Directive 76\/769\/EEC on the approximation of the laws, regulations and administrative provisions of the Member States relating to restrictions on the marketing and use of certain dangerous substances and preparations","volume":"188","year":"1994","unstructured":"Directive 94\/27\/EC of 30 June 1994 amending for the 12th time Directive 76\/769\/EEC on the approximation of the laws, regulations and administrative provisions of the Member States relating to restrictions on the marketing and use of certain dangerous substances and preparations. Off J Eur Union. 1994; L188:1\u20132.","journal-title":"Off J Eur Union"},{"key":"e_1_3_1_12_2","first-page":"51","article-title":"Directive 2004\/96\/EC of 27 September 2004 amending Council Directive 76\/769\/EEC as regards restrictions on the marketing and use of nickel for piercing post assemblies for the purpose of adapting its Annex I to technical progress","volume":"301","year":"2004","unstructured":"Directive 2004\/96\/EC of 27 September 2004 amending Council Directive 76\/769\/EEC as regards restrictions on the marketing and use of nickel for piercing post assemblies for the purpose of adapting its Annex I to technical progress. Off J Eur Union. 2004; L301:51\u201352.","journal-title":"Off J Eur Union"},{"key":"e_1_3_1_13_2","first-page":"24","article-title":"Directive 2003\/53\/EC of The European Parliament and of The Council of 18 June 2003 amending for the 26th time Council Directive 76\/769\/EEC relating to restrictions on the marketing and use of certain dangerous substances and preparations (nonylphenol, nonylphenol ethoxylate and cement)","volume":"178","year":"2003","unstructured":"Directive 2003\/53\/EC of The European Parliament and of The Council of 18 June 2003 amending for the 26th time Council Directive 76\/769\/EEC relating to restrictions on the marketing and use of certain dangerous substances and preparations (nonylphenol, nonylphenol ethoxylate and cement). Off J Eur Union. 2003; L178:24\u201327.","journal-title":"Off J Eur Union"},{"key":"e_1_3_1_14_2","unstructured":"Commission Regulation. (EU) No 301\/2014 of 25 March 2014 amending Annex XVII to Regulation (EC) No 1907\/2006 of the European Parliament and of the Council on the Registration Evaluation Authorisation and Restriction of Chemicals (REACH) as regards chromium VI compounds. Available from: https:\/\/eur-lex.europa.eu\/legal-content\/EN\/TXT\/PDF\/?uri=CELEX:32014R0301&from=de [Last accessed: February2 2026]."},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12782"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.15261"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13422"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2018.09.058"},{"key":"e_1_3_1_19_2","first-page":"113","article-title":"Regulation on the Registration, Evaluation, Authorization and Restriction of Chemicals","volume":"30105","year":"2017","unstructured":"Regulation on the Registration, Evaluation, Authorization and Restriction of Chemicals. Turkish Republic Official Gazette. 2017; 30105(repeated):113\u2013114. Available from: https:\/\/www.resmigazete.gov.tr\/eskiler\/2017\/06\/20170623M1-18.htm [February 2, 2026].","journal-title":"Turkish Republic Official Gazette"},{"key":"e_1_3_1_20_2","first-page":"121","article-title":"Regulation on the Registration, Evaluation, Authorization and Restriction of Chemicals","volume":"30105","year":"2017","unstructured":"Regulation on the Registration, Evaluation, Authorization and Restriction of Chemicals. Turkish Republic Official Gazette. 2017; 30105(repeated):121\u2013122. Available from: https:\/\/www.resmigazete.gov.tr\/eskiler\/2017\/06\/20170623M1-18.htm [February 2, 2026].","journal-title":"Turkish Republic Official Gazette"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0536.2002.460104.x"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12432"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.2340\/00015555924447"},{"key":"e_1_3_1_24_2","first-page":"79","article-title":"Kriterien zur Beurteilung der atopischen Hautdiathese","volume":"39","author":"Diepgen TL","year":"1991","unstructured":"Diepgen TL, , Fartasch M, , Hornstein OP. Kriterien zur Beurteilung der atopischen Hautdiathese. Dermatosen. 1991; 39:79\u201383.","journal-title":"Dermatosen"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.2011.01964.x"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.2174\/1874838400801010042"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(89)70096-7"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5154.110846"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.5070\/D39GT0826V"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.2310\/6620.2011.11035"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.2009.01650.x"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.2007.01220.x"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.2010.01751.x"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12582"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1097\/DER.0000000000000516"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13327"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2021.03.028"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(99)70154-4"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13767"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12346"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12726"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00105-019-04506-0"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13704"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.1097\/DER.0000000000000729"},{"key":"e_1_3_1_45_2","doi-asserted-by":"publisher","DOI":"10.1097\/DER.0000000000000417"},{"key":"e_1_3_1_46_2","doi-asserted-by":"publisher","DOI":"10.1097\/DER.0000000000000419"},{"key":"e_1_3_1_47_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12846"},{"key":"e_1_3_1_48_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.12556"},{"key":"e_1_3_1_49_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12113"},{"key":"e_1_3_1_50_2","doi-asserted-by":"publisher","DOI":"10.1097\/DER.0000000000000130"},{"key":"e_1_3_1_51_2","doi-asserted-by":"publisher","DOI":"10.1111\/ajd.14611"},{"key":"e_1_3_1_52_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ad.2013.12.003"},{"key":"e_1_3_1_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2015.07.011"},{"key":"e_1_3_1_54_2","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.20026"},{"key":"e_1_3_1_55_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.2008.01469.x"},{"key":"e_1_3_1_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(93)70281-W"},{"key":"e_1_3_1_57_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0105-1873.2006.00773.x"},{"key":"e_1_3_1_58_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12436"},{"key":"e_1_3_1_59_2","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5154.91834"},{"key":"e_1_3_1_60_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.1986.tb01193.x"},{"key":"e_1_3_1_61_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.12692"},{"key":"e_1_3_1_62_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12022"},{"key":"e_1_3_1_63_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13938"},{"key":"e_1_3_1_64_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12946"},{"key":"e_1_3_1_65_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.2008.01497.x"},{"key":"e_1_3_1_66_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12568"},{"key":"e_1_3_1_67_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2005.00693.x"},{"key":"e_1_3_1_68_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.14820"},{"key":"e_1_3_1_69_2","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13710"},{"key":"e_1_3_1_70_2","doi-asserted-by":"publisher","DOI":"10.1097\/DER.0000000000000200"},{"key":"e_1_3_1_71_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0105-1873.2005.00577.x"},{"key":"e_1_3_1_72_2","doi-asserted-by":"publisher","DOI":"10.1097\/01634989-200306000-00006"}],"container-title":["Dermatitis\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17103568261450838","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17103568261450838","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17103568261450838","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T07:46:44Z","timestamp":1780904804000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17103568261450838"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":71,"alternative-id":["10.1177\/17103568261450838"],"URL":"https:\/\/doi.org\/10.1177\/17103568261450838","relation":{},"ISSN":["1710-3568","2162-5220"],"issn-type":[{"value":"1710-3568","type":"print"},{"value":"2162-5220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]},"article-number":"17103568261450838"}}