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Gold Contact Allergy — SCE Dermatology MCQ

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HardInflammatory DermatosesGold Contact AllergySCE Dermatology

A 30-year-old woman has suspected allergic contact dermatitis to her wedding ring. She is patch test positive to gold sodium thiosulfate. Gold allergy has what characteristic patch test behaviour?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Gold allergy characteristically shows DELAYED positivity — reactions may only become positive at day 7 or later; standard 48/96-hour readings may miss gold allergy

Gold contact allergy has a distinctive patch test characteristic: reactions are frequently delayed, becoming positive only at day 7 (or even day 14-21) readings. Standard D2/D4 readings may therefore miss gold allergy — extended reading at D7 is essential when gold allergy is suspected. Gold allergy is the second most common metal allergy after nickel and can cause eyelid dermatitis (from touching jewellery then face), ring dermatitis, and widespread dermatitis from gold dental work or implants. White and rose gold contain varying amounts of gold mixed with other metals (nickel, palladium) which may independently cause allergy. Pure 24-karat gold is less likely to cause reactions than lower-karat alloys.

Reference: BAD 2017 Contact Dermatitis; ESCD