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Year : 2006  |  Volume : 51  |  Issue : 4  |  Page : 283-285
Patch testing: Broadened spectrum of indications

Institute of Allergic and Immunologic Skin Diseases (IAISD), Kolkata, India

Correspondence Address:
Sanjay Ghosh
IAISD, 27/2C, Bakultala Lane, Kolkata - 700 042
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5154.30297

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How to cite this article:
Ghosh S. Patch testing: Broadened spectrum of indications. Indian J Dermatol 2006;51:283-5

How to cite this URL:
Ghosh S. Patch testing: Broadened spectrum of indications. Indian J Dermatol [serial online] 2006 [cited 2022 Jan 28];51:283-5. Available from:

   Introduction Top

The principle of patch testing is to reproduce, in a clinical setting, a min-model of allergic contact dermatitis using allergens suspended in a vehicle at non-irritant concentration.[1],[2]

Patch test was first employed in 1847 by Staedler by blotting paper method to test idiosyncrasy. Collins, an ophthalmologist, in 1889, applied atropine patches to his patients who were developing adverse reaction after instillation of atropine. However, Jadassohn has been rightly called the father of patch testing as he first scientifically established the role of patch testing in dermatitis medicamentosa. Later on Sulzberger contributed much by working on and highlighting the importance and standardization of patch testing, which represents one of the most important advances in clinical dermatology during the twentieth century.[3]

Sulzberger and Wise[4] in 1931 commented that in eczema and dermatitis patch test should be employed, for it and it alone, can aid in the quest of the etiologic factor and in the study of the dermatitis. Colman in 1982 warned that the greatest abuse of patch testing is failure to use the test.[5] In 1986 Fisher concluded that properly applied and correctly interpreted patch tests are, at present, the only scientific 'proof' of allergic contact dermatitis.[6] He also cautioned that education in the technique of patch testing is as essential to physicians in training as the learning of most surgical procedures.

   Allergic Contact Dermatitis Syndrome (ACDS) Top

However, in course of time, the concept of allergic contact dermatitis have been widened. Recently this whole spectrum of allergic contact dermatitis has been described under the umbrella of ACDS.[7] The three stages of ACDS has been defined as follows:

Stage 1. The skin symptoms are limited to the site(s) of application of contact allergen(s)

Stage 2. There is a regional dissemination of symptoms (via lymphatic vessels), extending from the site of application of allergen(s)

State 3. Corresponds to the hematogenous dissemination of either allergic contact dermatitis (ACD) at a distance (stage 3A) or systemic reactivation of ACD (stage 3B).

The patch test remains the mainstay of etiological diagnosis for all stages of ACDS.[8]

   Non-eczematous Contact Dermatitis Top

Contact dermatitis sometimes do not present clinical features of classical eczematous dermatitis. Instead they manifest as different morphological pattern of eruption other than eczema.[2],[8],[9] [Table - 1] shows various types of non-eczematous contact dermatitis. Recently a Indian series of 39 cases of lichenoid contact dermatitis has been documented.[10] Even in these non-eczematous variants of ACD, patch testing is equally useful; the clinical signs of positive patch test reactions are usually eczematous in nature and therefore identical to those observed in 'classic' ACD. [8]

   Endogenous Eczema Top

Patch testing is also highly recommended in patients suffering from various type of eczematous conditions, which are considered endogenous in origin either partly or entirely [Table - 2]. The rationality behind the strategy lies on the fact that in many cases ACD may worsen the original underlying dermatitis. Avoidance of contact allergens may aid in the management of the eczematous conditions. Patch testing with topical corticosteroids, antibacterials, antifungals, preservatives, and different vehicles may help to choose the correct medicaments and cosmetics for the sufferers.[8]

   Psoriasis and Others Top

Similarly in psoriasis, especially palmoplantar variety,[12] impaired epidermal barrier function and use of various topical preparation may lead to superimposed ACD quite often. These patients should be patch tested with topical corticosteroids and vitamin D 3 analogues (calcipotriol, tacalcitols, calcitriol) whenever possible. Apart from this patch testing may be indicated in any other skin conditions, whenever the physician suspects past or recent history of superimposed ACD.[8]

Beside these, few morphological appearance of dermatological diseases may warrant patch testing as shown in [Table - 3].[13]

   Conclusions Top

Patch test represents a very useful diagnostic tool which can be utilized to solve the puzzle of many dermatoses in which etiology remains obscure or management approach creates dilemma. In non-infective inflammatory disorder of skin the role of patch test is being explored constantly and in future, if not over-stated, patch test may be recommended as routine testing procedure in these dermatoses. [Table - 4] summarizes the indications of patch test.

   References Top

1.Por A, Ket NS. Investigative techniques in contact dermatitis. In : Ket NS, Goh CL, editors. The Principles and Practice of Contact and Occupational Dermatology in the Asia-Pacific Region. World Scientific: New Jersey; 2001. p. 47-57.  Back to cited text no. 1      
2.Ghosh S. Atlas and Synopsis of Contact and Occupational dermatology. 1st ed. Institute of Allergic and Immunologic Skin Diseases: Kolkata; 2006. p .25-61.  Back to cited text no. 2      
3.Bajaj AK. Patch testing: An overview. In : Ghosh S, editor. Recent Advances in Dermatology. Jaypee Brothers: Delhi; 2004. p. 136-6.  Back to cited text no. 3      
4.Subzberger MB, Wise F. The contact or patch test in dermatology. Arch Dermatol Syph 1931;29:519-31.  Back to cited text no. 4      
5.Colman CD. The use and abuse of patch tests. In : Maibach HI, Gollin GA, editors. Occupational and Industrial Dermatology. Mosby: Chicago; 1982. p. 131-2.  Back to cited text no. 5      
6.Fisher AA. Contact dermatitis. 2nd ed. Lea and Febiger: Philadelphia; 1986. p. 31-108.  Back to cited text no. 6      
7.Sugai T. Contact dermatitis syndrome and unusual skin manifestations. Skin Res 1988;30:8-17.  Back to cited text no. 7      
8.Lachapelle JM. The spectrum of diseases for which patch testing is recommended. In : Lachepelle JM, Maibach HI, editors. Patch testing prich testing: A practical guide. Springer: Berlin; 2003;7-26.  Back to cited text no. 8      
9.Goh CL. Non-Eczemtous Contact Dermatitis. In : Ket NS, Goh CL, editors. The Principles and Practice of Contact and Occupational Dermatology in the Asia-Pacific Region. World Scientific: New Jersy; 2001. p. 22-71.  Back to cited text no. 9      
10.Mukhopadhaya S, Hawelia D, Ghosh S. Lichenoid Contact dermatitis:Epidemio. clinico-allergological study of 39 cases. Abstracts, National Conference of Contact and Occupational Dermatoses Forum of India (CODFI). Mumbai; 2006, 30.  Back to cited text no. 10      
11.Haldar S, Sarma N, Ghosh S. Clinico-Allegological study of 31 cases of pompholyx induced by systemic reactivation of contact dermatitis (SRCD), Abstracts, National Conference of Contact and Occupational Dermatoses (CODFI). Mumbai, 2006, 25.  Back to cited text no. 11      
12.Ghosh S. Concomitant contact dermatitis in hand and foot psoriasis. Abstracts, 33rd Annual Conference of IADVL and 4th SARCD: New Delhi; 2005. p. 146.  Back to cited text no. 12      
13.Marks JG, Elsmer P, Deleo VA. Contact and occupational dermatology. 3rd ed. Mosby: London; 2002. p. 16-33.  Back to cited text no. 13      


  [Table - 1], [Table - 2], [Table - 3], [Table - 4]

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