[Grade IIb alkali burns of the lower extremities. Working with concrete]. / Arbeiten mit Beton. Grad-IIb-Laugenverätzung der unteren Extremität.

The irritating effects of concrete (calcium oxide) on skin have long been known. The effect by long-term skin exposure is not only irritating but also erosive and alkali skin erosion may result due to colliquative skin necrosis. A complicated course may ensue potentially necessitating plastic reconstructive treatment due to the development of unstable scars and defects. Correct interpretation of the skin trauma and adequate treatment are mandatory for functional restitution.

Superficial femoral artery nitinol stent in a patient with nickel allergy.

We present a case of a patient who developed a systemic allergic reaction following placement of a nitnol stent in the superficial femoral artery for claudication symptoms. Shortly after, he was tested for contact dermatitis and found to have a severe reaction to nickel. His symptoms of severe itch and generalized rash resolved within days following stent explantation and reconstruction with a vein graft. The epidemiology and clinical significance of nickel allergy and the concomitant use of nickel-alloy stents are discussed.

[Hurt eczematiforme column (chronicle) of the breast after implementation of a surgical clip]. / Lésion eczématiforme chronique du sein après mise en place d'un clip chirurgical.

We report a case of atopic dermatitis in relation with a surgical titanium clip. Such a complication has only been reported once in the literature. We advocate to ask the patients about query atopic manifestations especially contact dermatitis to metal before any procedure involving metallic implants.

[Alternative materials and solutions in total knee arthroplasty for patients with metal allergy]. / Alternative Werkstoffe und Lösungen in der Knieendoprothetik für Patienten mit Metallallergie.

The annual number of total knee replacement implantations is rising continuously. A progressive cutaneous hypersensitivity rate against metallic materials in the population has been registered which can lead to an increase of allergy-induced reactions associated with implant loosening in the future although the correlation with an allergic cutaneous sensitisation has not been proven in all cases. On apparent allergy against metallic implant components different alternative solutions to standard endoprostheses should be taken into account for primary implantation or revision of total knee replacement, for example the application of implant components without metallic elements (e.g. ceramics), the use of non-allergic metallic implants, such as titanium or ZrNb alloys, or potential allergy-inducing metallic materials after masking the implant surface using a suitable coating. In the case of primary or revision surgery most patients with metal allergy are treated with a Ti(Nb)N-coated knee implant made of cobalt-chrome or titanium alloys in our hospital. Within an international multi-centre study we are currently implanting a newly developed knee endoprosthesis system with a ceramic femoral component as an alternative.

[Lichenoid pseudolymphomatous tattooing reaction]. / Lichenoid-pseudolymphomatöse Tätowierungsreaktion.

A 35 year old patient developed swellings in the red colored areas of his tattoo. Histological examination revealed a lichenoid, pseudolymphomatous infiltrative pattern, that could be distinguished from frank lymphoma by means of electron microscopy, immunohistochemistry and molecular biology. The presence of dermal dendritic cells suggests a dermal-allergic pathogenesis of non-granulomatous tattoo reactions. Therapy of choice is an excision of the inflamed areas.

[Contact allergy-induced tracheal stenosis caused by vulcanization accelerators in the endotracheal tube?]. / Kontaktallergisch bedingte Trachealstenose durch im Tubus vorhandene Vulkanisationsbeschleuniger?

Tracheal stenoses occur mainly under iatrogenic conditions: they develop specially after long-term intubation, but also after tracheotomy. Etiological-pathogenic relevant factors include the mechanical irritation of mucosa, perichondrium and cartilage in addition to infected tracheal secretions. An allergic cell-mediated reaction in the respiratory tract has been already described. It is seldom recognized. The possibility of such a hyperergic, allergic, delayed reaction (Type IV Coombs-Gell response) with subsequent tracheal stenosis caused by rubber chemicals (accelerators) found in endotracheal tubes is presented in the following case report.