Dyshidrotic Eczema Associated with Contraceptive Tubal Occlusion Device

Abstract

Nickel-related hypersensitivity reactions associated with the Essure micro-insert (Contraceptive Tubal Occlusion Device and Delivery System) are extremely rare, with only four reports in the current literature. We present a case of a 37-year-old woman who presented to our clinic for initial dermatologic evaluation of dermatitis localized to both hands three years after device placement. A diagnosis of dyshidrotic eczema, classically associated with systemic nickel exposure, was made after careful clinical and histopathologic evaluation. The micro-insert contraceptive device was suspected as the cause given our patient’s self-reported history of nickel allergy, which was further supported by positive patch test results. Currently, our patient has seen significant improvement in her condition with topical steroids and occasional intralesional steroid injections. This case represents a diagnostic challenge given the presentation of a seemingly localized dermatitis secondary to systemic nickel exposure from a distant source. In addition, the delayed development of our patient’s rash posed a clinical challenge in drawing a causal relationship between device placement and her allergic reaction. Practitioners should be cognizant of eliciting a history of implanted devices (plates, screws, implants, endovascular prostheses etc.) for all patients, even if the allergic reaction is seemingly localized such as dyshidrotic eczema.