Ann Dermatol.  2013 Aug;25(3):356-359. 10.5021/ad.2013.25.3.356.

Metallic Discoloration on the Right Shin Caused by Titanium Alloy Prostheses in a Patient with Right Total Knee Replacement

Affiliations
  • 1Department of Dermatology, College of Medicine, Yeungnam University, Daegu, Korea. dhshin@med.yu.ac.kr

Abstract

The differential diagnosis of bluish-gray pigmentation of the skin includes dermal melanocytosis, malignant melanoma and metallic discoloration. Of these disorders, metallic discoloration, which develops from deposits of fine metallic particles on the skin, is an uncommon dermatologic disease. We report a case of metallic discoloration of the right shin caused by titanium alloy prostheses in a patient with right total knee replacement. The patient had bluish-gray pigmentation on her right shin as well as pain while walking. Histopathologic findings of the skin lesion showed abundant black particles in the perivascular area of the lower dermis. Polarizing microscopy revealed refractile foreign materials in the dermis. An energy dispersive X-ray spectrophotometer unit attached to a transmission electron microscope detected titanium and aluminium peaks in the specimen.

Keyword

Metallic discoloration; Titanium-aluminium alloy; Total knee replacement

MeSH Terms

Alloys
Arthroplasty, Replacement, Knee
Dermis
Diagnosis, Differential
Electrons
Humans
Melanoma
Microscopy
Pigmentation
Prostheses and Implants
Skin
Titanium
Walking
Alloys
Titanium

Figure

  • Fig. 1 (A) A 10×15 cm sized skin lesion is observed on the right shin. (B) The skin lesion show blue to gray colored patch.

  • Fig. 2 (A, B) Black particle deposits on the perivascular area in the dermis (black circles) (A: H&E, ×40; B: H&E, ×400). (C) Melanin in the epidermal basal layer (arrows) and black particles around vessels in the dermis (circle) are positive for melanin stain (×200). (D) Positive staining of black particles around vessels in the dermis (circle) and negative staining of melanin in the epidermal basal layer (Demelanin, ×200).

  • Fig. 3 Findings from polarizing microscopy reveal refractile foreign materials (arrows) in the skin specimen (H&E, ×200).

  • Fig. 4 Findings from energy dispersive X-ray analysis of black particles around vessels in the dermis show peaks for titanium (Ti), aluminium (Al), carbon (C), sodium (Na), chlorine (Cl) and vanadium (V).

  • Fig. 5 During the revision operation, periprosthetic tissues from the interface to the joint capsule show black pigments.


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