Alopecia due to an allergic reaction to metal head-pins used in a neurosurgical operation

BACKGROUND: Allergic reactions to the metal head-pins of a head fixation holder are rare. CASE DESCRIPTION: A 45-year-old woman was referred to our hospital for the treatment of unruptured cerebral aneurysms. She underwent successful surgical treatment using four head-pins of the Sugita frame. At her first outpatient visit 3 weeks after discharge, redness, sores, and focal hair loss were noted at all four areas where the pinning had been performed. The pin fixation was considered to be responsible for the alopecia because the condition of the scalp lesions was even in all four parts. Six months later, the scalp regained hair. The head-pins were made of stainless steel, containing iron, nickel, chromium, and other components. A previous history of contact dermatitis to metal jewellery was later proven. CONCLUSION: The history of metal allergy should have been carefully elicited because head fixation with head-pins is essential for neurosurgical procedures.