Could it be the stainless steel in his arm?

[itsalwaysomething]

Not sure if this belongs under allergy or dermatology but here goes...

My son had surgery to repair a broken ulna and radius in his left arm.  Surgical stainless steel plates and screws were used.  He was not casted but was given a sleeve-like bandage and a plastic splint which he wore for 6 weeks.  Into the 3rd week, he started to develop a blistery rash on his left hand.  We had the blisters tested for staph (negative).  Also blood work was done to rule out infection.  The rash moved up his inner arm near his incision.  We changed the sleeve he was wearing to a cotton sock thinking that he was having an allergic reaction to the bandage.  After about a week of Cortaid, the rash subsided but returned after 3 days and again ran up his arm.  It was itchy and looked like poison ivy.  By week 5 he had spots of the rash on his neck, chin and face.  His pediatrician put him on a 5 day dose of prednisone and hydrocortisone valerate 0.2%.  During the next week he was removed from the sleeve and splint and began physical therapy.  We sought the advice of a dermatologist who put him on an extended dose of prednisone and triamcinolone acetonide cream 0.1%.  The rash went away after about a week.  The next week he was patch tested using T.R.U.E.  He had mild to moderate reactions to nickel, neomycin, mercapto and fragrances.  A new skin condition has recently appeared on both hands with blisters and peeling skin.  We are currently using Aquaphor at night with gloves which seems to be helping.

Is it a coincidence that this has all occurred after he had surgery?  Is it possible that this is an allergic reaction to the stainless steel in his arm?  I not sure where to go with this at this point.

[Bhupinder Kaur, MD]

Hello,

Yes you are right in saying that some of the sutures have chromium.We call them chromic catgut sutures.They are absorbable, surgical sutures composed of highly purified connective tissue (mostly collagen) derived from either beef or sheep intestines and covered with chromium salt solution to delay absorption.Moreover chromium can be used in the composition of stainless steel also.So it is good that you have decided to check the composition with your son’s doctor.

Hope it helps.Take care and pls do keep me posted if you have any additional doubts. Kind regards.

[itsalwaysomething]

Thank you.  I have called the orthopedic and asked to check with his rep on the composition of the stainless steel (% nickel, chromium, etc.).  I also understand that some absorbable suctures can also contain chromium.

I will keep you posted.

[Bhupinder Kaur, MD]

Hello,

Allergy to st5ainless steel is very rare.Sometimes the stainless steel implants and screws have nickel in them which provides a smooth and polished finish.As you son has shown allergy to nickel on patch testing,so it is possible that he is showing allergic reaction to nickel in the implant.

Pls confirm it from the manufacturer of the implant and screws whether nickel has been used in it.

Hope this information helps.Take care and pls do keep me posted on how your son is doing or if you have any additional queries