Advertisement

Pitfalls and Errors in Patch Testing: Suggestions for Quality Assurance

  • Peter U. ElsnerEmail author
  • Sibylle Schliemann
Chapter

Abstract

Patch testing is a complex procedure requiring considerable knowledge, experience, and infrastructure. As all comparable medical procedures, it is prone to pitfalls and errors. These relate to patient selection; selection and preparation of patch test allergens; their application, reading, and interpreting the patch test reaction; and judging patch test relevance. In this chapter, frequent pitfalls and errors encountered in patch testing are described. With an up-to-date quality assurance system in the patch test unit, they can be prevented with a high probability.

Keywords

Contact Dermatitis Patch Test Allergic Contact Dermatitis Patch Test Reaction Irritant Reaction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Wilf-Miron R, Lewenhoff I, Benyamini Z, Aviram A. From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care. Qual Saf Health Care. 2003;12(1):35–9.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Moshell AN, Parikh PD, Oetgen WJ. Characteristics of medical professional liability claims against dermatologists: data from 2704 closed claims in a voluntary registry. J Am Acad Dermatol. 2012;66(1):78–85.PubMedCrossRefGoogle Scholar
  3. 3.
    Nethercott JR. Practical problems in the use of patch testing in the evaluation of patients with contact dermatitis. Curr Probl Dermatol. 1990;2(4):97–123.CrossRefGoogle Scholar
  4. 4.
    Lamb SR, Wilkinson SM. Audit of primary and secondary care as a source of patch test clinic referrals. Br J Dermatol. 2004;151(6):1258–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Corazza M, Borghi A, Mantovani L, Virgili A. Analysis of patch test referrals: influence of appropriateness of referrals on sensitization rate. Contact Dermatitis. 2012;66(2):95–100.PubMedCrossRefGoogle Scholar
  6. 6.
    Devos SA, Van Der Valk PG. The risk of active sensitization to PPD. Contact Dermatitis. 2001;44(5):273–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Bruze M, Condé-Salazar L, Goossens A, Kanerva L, White IR. Thoughts on sensitizers in a standard patch test series. The European Society of Contact Dermatitis. Contact Dermatitis. 1999;41(5):241–50.PubMedCrossRefGoogle Scholar
  8. 8.
    Mitchell J, Maibach HI. Managing the excited skin syndrome: patch testing hyperirritable skin. Contact Dermatitis. 1997;37(5):193–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Lindberg M, Matura M. Contact dermatitis. Heidelberg/New York: Springer; 2011.Google Scholar
  10. 10.
    Belsito DV. Patch testing with a standard allergen (“screening”) tray: rewards and risks. Dermatol Ther. 2004;17(3):231–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Sköld M, Hagvall L, Karlberg A-T. Autoxidation of linalyl acetate, the main component of lavender oil, creates potent contact allergens. Contact Dermatitis. 2008;58(1):9–14.PubMedCrossRefGoogle Scholar
  12. 12.
    Frosch PJ, Geier J, Uter W, Goossens A. Patch testing with the patients’ own products. In: Contact dermatitis. Heidelberg/New York: Springer; 2011. p. 1107–19.CrossRefGoogle Scholar
  13. 13.
    Isaksson M, Gruvberger B, Frick-Engfeldt M, Bruze M. Which test chambers should be used for acetone, ethanol, and water solutions when patch testing? Contact Dermatitis. 2007;57(2):134–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Bruze M, Isaksson M, Gruvberger B, Frick-Engfeldt M. Recommendation of appropriate amounts of petrolatum preparation to be applied at patch testing. Contact Dermatitis. 2007;56(5):281–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Bruze M, Frick-Engfeldt M, Gruvberger B, Isaksson M. Variation in the amount of petrolatum preparation applied at patch testing. Contact Dermatitis. 2007;56(1):38–42.PubMedCrossRefGoogle Scholar
  16. 16.
    Frick-Engfeldt M, Gruvberger B, Isaksson M, Hauksson I, Pontén A, Bruze M. Comparison of three different techniques for application of water solutions to Finn Chambers®. Contact Dermatitis. 2010;63(5):284–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Gilpin SJ, Hui X, Maibach HI. Volatility of fragrance chemicals: patch testing implications. Dermatitis. 2009;20(4):200–7.PubMedGoogle Scholar
  18. 18.
    Uter W, Hegewald J, Kränke B, Schnuch A, Gefeller O, Pfahlberg A. The impact of meteorological conditions on patch test results with 12 standard series allergens (fragrances, biocides, topical ingredients). Br J Dermatol. 2008;158(4):734–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Brasch J, Geier J, Henseler T. Evaluation of patch test results by use of the reaction index. An analysis of data recorded by the Information Network of Departments of Dermatology (IVDK). Contact Dermatitis. 1995;33(6):375–80.PubMedCrossRefGoogle Scholar
  20. 20.
    Maibach HI, Fregert S. Manual of contact dermatitis. Contact Dermatitis. 1980;6(7):430–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Fregert S. Manual of contact dermatitis: on behalf of the International Contact Dermatitis Research Group. Copenhagen: Munksgaard; 1974.Google Scholar
  22. 22.
    Svedman C, Isaksson M, Björk J, Mowitz M, Bruze M. ‘Calibration’ of our patch test reading technique is necessary. Contact Dermatitis. 2012;66(4):180–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Becker D. Allergic contact dermatitis. J Dtsch Dermatol Ges. 2013;11(7):607–21.PubMedGoogle Scholar
  24. 24.
    Löffler H, Becker D, Brasch J, Geier J, German Contact Dermatitis Research Group (DKG). Simultaneous sodium lauryl sulphate testing improves the diagnostic validity of allergic patch tests. Results from a prospective multicentre study of the German Contact Dermatitis Research Group (Deutsche Kontaktallergie-Gruppe, DKG). Br J Dermatol. 2005;152(4):709–19.PubMedCrossRefGoogle Scholar
  25. 25.
    Schuster C, Mofarrah R, Aberer W, Kränke B. Pitfalls of patch testing with dental materials. Br J Dermatol. 2012;166(3):674–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Maurice PD, Rivers JK, Jones C, Cronin E. Dermatitis artefacta with artefact of patch tests. Clin Exp Dermatol. 1987;12(3):204–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Mowad CM. Patch testing: pitfalls and performance. Curr Opin Allergy Clin Immunol. 2006;6(5):340–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Davis MDP, Bhate K, Rohlinger AL, Farmer SA, Richardson DM, Weaver AL. Delayed patch test reading after 5 days: the Mayo Clinic experience. J Am Acad Dermatol. 2008;59(2):225–33.PubMedCrossRefGoogle Scholar
  29. 29.
    Jonker MJ, Bruynzeel DP. The outcome of an additional patch-test reading on days 6 or 7. Contact Dermatitis. 2000;42(6):330–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Lachapelle JM. A proposed relevance scoring system for positive allergic patch test reactions: practical implications and limitations. Contact Dermatitis. 1997;36(1):39–43.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of DermatologyUniversity Hospital JenaJenaGermany

Personalised recommendations