mercuric-chloride--ammoniated and Hypersensitivity

The results on thimerosal (Merthiolate) hypersensitivity of a retrospective study, together with the relevant data on thimerosal hypersensitivity referred to in the literature up to 1993, are presented. Positive patch test reactions to thimerosal (0.1% pet.) were observed in 32 (1.3%) of 2461 adult patients with suspected contact allergy examined in the period 1987-1992. 20 (0.8%) patients had a solitary positive patch test to thimerosal. The observed incidence is low. Clinical symptoms related to thimerosal hypersensitivity were observed in only 3 patients. The collected results are discussed with emphasis on the clinical implications of sensitization to thimerosal. It appears that a positive patch test to thimerosal is frequently clinically irrelevant.

Topics: Adult; Ammonia; Balsams; Dermatitis, Contact; Ethylenediamines; Eugenol; Female; Humans; Hypersensitivity; Hypersensitivity, Delayed; Incidence; Irritants; Male; Mercuric Chloride; Middle Aged; Netherlands; Nickel; Patch Tests; Perfume; Phenylmercury Compounds; Retrospective Studies; Thimerosal

Oral lichenoid lesions (OLL) or lichen-planus-like lesions are often idiopathic. Our aim was to determine whether OLL can be caused by allergy to mercury in amalgam fillings, and whether resolution of OLL occurs after replacement of amalgam with other dental fillings. Patients with only OLL (except for 1 case with cutaneous lichen planus) referred for patch testing during 1985-1994 to the Contact and Occupational Dermatitis Clinic of the Skin & Cancer Foundation, Darlinghurst, were reviewed. Patch tests were performed with 1% mercury, 1% ammoniated mercury, 0.1% thimerosal, 0.1% mercuric chloride, 0.05% phenylmercuric nitrate and an amalgam disc, using Finn Chambers occluded for 2 days, 19 patients (17 women and 2 men; age range: 28-72 years) had OLL in close contact with amalgam fillings and showed positive patch test reactions to mercury compounds, 16 out of 19 patients had their amalgam fillings replaced. In 13 patients, the OLL healed. 1 patient had marked improvement. 1 patient had no improvement and developed multiple oral squamous cell carcinoma. In conclusion, OLL can be caused by allergy to mercury in amalgam fillings. Replacement of amalgam with other dental fillings usually results in resolution of OLL and is recommended for cases with positive patch test reactions to mercury compounds.

Topics: Adult; Aged; Ammonia; Anti-Infective Agents, Local; Carcinoma, Squamous Cell; Dental Amalgam; Dental Materials; Dental Restoration, Permanent; Dermatitis, Allergic Contact; Disinfectants; Female; Follow-Up Studies; Humans; Hypersensitivity; Lichen Planus, Oral; Male; Mercuric Chloride; Mercury; Middle Aged; Mouth Neoplasms; Patch Tests; Phenylmercury Compounds; Preservatives, Pharmaceutical; Thimerosal

Epicutaneous patch testing of a battery of 35 dental test substances was carried out in 24 patients with visible lichenoid oral mucosal lesions and in 24 patients with burning mouth syndrome (BMS) without any visible lesions. Reactions to mercury ammonium chloride were found in 33% (8/24) of the patients with visible lesions compared to 0% (0/24) of the patients with BMS. The difference was statistically significant. In 7 of the 8 patients who reacted to mercury, total or partial regression of the lesions was observed after removal of dental amalgam. Reactions to nickel sulfate were found in 21% (5/24) of the patients with BMS compared to 3% (1/24) of the patients with lichenoid lesions. This difference was also statistically significant. Nickel is a rare component in dental restorations, but the oral mucosa is daily exposed to nickel through food and water intake. Removal of nickel from the environment of the patient can therefore be hard to accomplish.

Topics: Adult; Aged; Allergens; Ammonia; Burning Mouth Syndrome; Dental Materials; Dental Restoration, Permanent; Dentures; Female; Follow-Up Studies; Humans; Hypersensitivity; Lichen Planus; Male; Mercuric Chloride; Middle Aged; Mouth Diseases; Nickel; Skin Tests