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DermNet NZ


Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



Patch tests (contact allergy testing)

Dermatologists apply patch tests in patients with dermatitis, to find out whether their skin condition may be caused or aggravated by a contact allergy. Patch tests are not the same as skin prick tests, which are used to diagnose hay fever allergy (house dust mite, grass pollens and cat dander). Skin prick tests have very limited value for patients with skin rashes.

The patch testing described here is as it is undertaken in Hamilton, New Zealand. There may be slight differences in methods used at other centres - if you are having patch tests done, ask your dermatologist to explain.

A range of substances can be used for patch testing. A baseline series such as the European Standard Series of allergens (or similar) is applied to nearly every patient, together with specific tests appropriate to the individual. Each substance (known as an allergen) has been tested to find the best concentration to demonstrate an allergic reaction without causing irritation to those who are not allergic to the material.

Sometimes the results can be inconclusive or misleading. Instead of one or two positive reactions, sometimes nearly all test areas become red and itchy. This is known as ‘angry back’ and is most likely to occur in those with very active dermatitis (false positive result). At other times, there may be little or no apparent reaction to a substance that regularly causes dermatitis in that person (false negative result).

Further testing may be necessary. Patch tests do not always explain the cause of a dermatitis.

Patch tests
Standard patch tests
T.R.U.E.® tests
T.R.U.E.® tests
Patch tests
Several positive results
Patch testing

More images of patch tests ...

The appointments

The first appointment will take about half an hour. Tiny quantities of 25 to 150 materials in individual square plastic or round aluminium chambers are applied to the upper back. They are kept in place with special hypoallergenic adhesive tape. The patches stay in place undisturbed for 48 hours.

At the second appointment, usually two days later, the patches will be removed. Sometimes further patches are applied. The back is marked with an indelible black felt tip pen or other suitable marker to identify the test sites.

These marks must still be visible at the third appointment, usually two days later (4 days after application). The back should be checked and if necessary remarked on several occasions between the 2nd and 3rd appointments.

The results

The dermatologist will complete a record form at the second and third appointments (usually 48 and 96 hour readings). The result for each test site is recorded. The system we use is as follows:

Irritant reactions include sweat rash, follicular pustules and burn-like reactions. Uncertain reactions refer to a pink area under the test chamber. Weak positives are slightly elevated pink or red plaques. Strong positives are ‘papulovesicles’ and extreme reactions are blisters or ulcers. The relevance depends on the site and type of dermatitis and the specific allergen. The interpretation of the results requires considerable experience and training.

Patch tests
- reaction (hair dye discolouration)
Patch tests
Irritant reaction
Patch tests
+/- reaction
Essentially negative patch test reactions
Patch tests
+ reaction
Patch tests
++ reaction
Patch tests
+++ reaction
Positive patch test reactions

Notes

Bring Your Own Materials For Testing

Discuss the particular substances with which you come into contact with your dermatologist; you may be asked to bring materials from home or work.

Photopatch tests

Some patients have photopatch tests because their dermatitis develops on skin exposed to the sun (photosensitivity). Two sets of perfumes, antiseptics, plant materials and sunscreens may be applied. After removal, one set is exposed to a small dose of ultraviolet radiation (UVA). This is not enough to cause a photosensitivity reaction on its own.

Adverse reactions to patch tests

Positive patch test results are small areas of active eczema / dermatitis. They will be itchy and may require treatment with topical steroid.

Patch tests: extension of dermatitis to surrounding skin
Extension of dermatitis to surrounding skin
Patch tests: dermatitis to tape
Dermatitis to tape
Patch tests
Angry back
Adverse reactions to patch testing

Related information

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If you have any concerns with your skin or its treatment, see a dermatologist for advice.