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Benzoyl peroxide: is it a relevant bone cement allergen in patients with orthopaedic implants?

Contact allergies to orthopaedic implant material are discussed to be relevant for postoperative complaints. We aimed at determining the prevalence of sensitizations to implant metals and to bone cements in patients with implants. We investigated 13 consecutive patients with suspicion of contact allergy to implant material. Epicutaneous patch testing was performed with metals and bone cement components including benzoyl peroxide (BPO). The chief complaints were skin disorders (n = 3), loosening of implant (n = 2), swelling (n = 6), and pain (n = 2). 6 patients had a sensitization to at least 1 allergen. 3 patients reacted to BPO, being of possible relevance in 1 of these patients suffering from dermatitis. Other sensitizations, such as those to nickel, fragrance, and balsam of Peru, were observed, with no clinical relevance (n = 1, respectively). BPO in bone cements may lead to type 4 sensitizations of which the relevance, however, remains questionable. Nevertheless we recommend this allergen to be tested in patients with complicated cemented orthopaedic implants.