“Doctor, Why Are My Patch Tests Negative?”

  • Denis SassevilleEmail author


It is expected that patch testing will be negative in up to 50 % of patients. When competent investigators who use comprehensive series of allergens perform the procedure, a negative result will usually signify a diagnosis other than allergic contact dermatitis and will be deemed a true-negative test. False-negative tests are likely to occur when the allergens responsible for the dermatitis are not tested, when early or late readings are not performed, or when procedures such as photopatch tests and prick tests are omitted. Technical failure may arise from insufficient occlusion, short application times, and insufficient amount, concentration, or inactivity of the allergen. The patient may be in a state of unresponsiveness because of ultraviolet light exposure of medication-induced immunosuppression, again leading to falsely negative patch tests.


Contact Dermatitis Patch Testing Allergic Contact Dermatitis Tinea Pedis Contact Allergy 
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  1. 1.
    Rietschel RL. Is patch testing cost-effective? J Am Acad Dermatol. 1989;21:885–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Nosbaum A, Vocanson M, Rozières A, Hennino A, Nicolas JF. Allergic and irritant contact dermatitis. Eur J Dermatol. 2009;19(4):1–8.Google Scholar
  3. 3.
    Larkin A, Rietschel RL. The utility of patch testing using larger screening series of allergens. Am J Contact Dermat. 1998;9:142–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Patel D, Belsito DV. The detection of clinically relevant contact allergens with a standard screening tray of 28 allergens. Contact Dermatitis. 2012;66:154–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Rycroft RJG. Problems in occupational allergy. Semin Dermatol. 1982;1:43–7.Google Scholar
  6. 6.
    Gollhausen R, Przybilla B, Ring J. Reproducibility of patch tests. J Am Acad Dermatol. 1989;21:1196–202.PubMedCrossRefGoogle Scholar
  7. 7.
    Brasch J, Henseler T, Aberer W, Baüerle G, Frosch PJ, Fuchs T, et al. Reproducibility of patch tests. A multicenter study of synchronous left versus right-sided patch tests by the German Contact Dermatitis Research Group. J Am Acad Dermatol. 1994;31:584–91.PubMedCrossRefGoogle Scholar
  8. 8.
    Lachapelle JM, Maibach HI. Additional testing procedures and spot tests. In: Lachapelle JM, Maibach HI, editors. Patch testing and prick testing. 3rd ed. Berlin/Heidelberg: Springer; 2012. p. 113–28.CrossRefGoogle Scholar
  9. 9.
    Rietschel RL, Fowler Jr JF. Fisher’s contact dermatitis. 6th ed. Hamilton: B.C. Decker Inc; 2008. p. 15.Google Scholar
  10. 10.
    Lindberg M, Matura M. Patch testing. In: Johansen JD, Frosch PJ, Lepoittevin JP, editors. Contact dermatitis. 5th ed. Berlin/Heidelberg: Springer; 2011. p. 439–64.CrossRefGoogle Scholar
  11. 11.
    Skog E, Forsbeck M. Comparison between 24- and 48-h exposure time in patch testing. Contact Dermatitis. 1978;4:362–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Kalimo K, Lammintausta K. 24- and 48-h allergen exposure in patch testing. Comparative study with 11 common contact allergens and NiCl2. Contact Dermatitis. 1984;10:25–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Goh CL, Wong WK, Ng SK. Comparison between 1-day and 2-day occlusion times in patch testing. Contact Dermatitis. 1994;31:48–50.PubMedCrossRefGoogle Scholar
  14. 14.
    Machácková J, Seda O. Reproducibility of patch tests. J Am Acad Dermatol. 1991;25:732–3.PubMedCrossRefGoogle Scholar
  15. 15.
    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;33:375–80.PubMedCrossRefGoogle Scholar
  16. 16.
    Manuskiatti W, Maibach HI. 1- versus 2- and 3-day diagnostic patch testing. Contact Dermatitis. 1996;35:197–200.PubMedCrossRefGoogle Scholar
  17. 17.
    Bruze M, Isaksson M, Gruvberger B, Frick-Engfeldt M. Recommendations of appropriate amounts of petrolatum preparations to be applied at patch testing. Contact Dermatitis. 2007;56:281–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Rycroft RJG. False reactions to nonstandard patch tests. Semin Dermatol. 1986;5:225–30.Google Scholar
  19. 19.
    De Groot A. Patch testing. Test concentrations and vehicles for 4350 chemicals. 3rd ed. Amsterdam: AC Degroot Publishing; 2008.Google Scholar
  20. 20.
    Matura M, Sköld M, Börje A, Andersen KE, Bruze M, Frosch P, et al. Selected oxidized fragrance terpenes are common contact allergens. Contact Dermatitis. 2005;52:320–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Hausen BM. Evaluation of the main contact allergens in oxidized tea tree oil. Dermatitis. 2004;15:213–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Sköld M, Börje A, Harambasic E, Karlberg AT. Contact allergens formed on air exposure of linalool. Identification and quantification of primary and secondary oxidation products and the effect on skin sensitization. Chem Res Toxicol. 2004;17:1697–705.PubMedCrossRefGoogle Scholar
  23. 23.
    Frick M, Zimerson E, Karlsson D, Marand A, Skarping G, Isaksson M, et al. Poor correlation between stated an found concentrations of diphenyl methane-4,4’-diisocyanate (4,4”-MDI) in petrolatum patch test preparations. Contact Dermatitis. 2004;51:73–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Mose KF, Andersen KE, Christensen LP. Stability of selected volatile contact allergens in different patch test chambers under different storage conditions. Contact Dermatitis. 2012;66:172–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Wilkinson SM, Beck MH. Corticosteroid contact hypersensitivity: what vehicle and concentration? Contact Dermatitis. 1996;34:305–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Serpentier-Daude A, Collet E, Didier AF, Touraud JP, Sgro C, Lambert D. Dermites de contact aux antiherpétiques locaux. Ann Dermatol Venereol. 2000;127:191–3.PubMedGoogle Scholar
  27. 27.
    Whitmore SE. The importance of proper vehicle selection in the detection of minoxidil sensitivity. Arch Dermatol. 1992;128:653–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Kellet JK, King CM, Beck MH. Compound allergy to medicaments. Contact Dermatitis. 1986;14:45–8.CrossRefGoogle Scholar
  29. 29.
    Le Coz CJ, Sasseville D. Interprétation et pertinence des patch tests: faux positifs et faux négatifs, allergies composées, allergies croisées. Ann Dermatol Venereol. 2009;136:610–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Sukanto H, Nater JP, Bleumink E. Influence of topically applied corticosteroids on patch test reactions. Contact Dermatitis. 1981;7:180–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Clark R, Rietschel R. The effect of triamcinolone acetonide ointment 0.1% on positive patch tests. Arch Dermatol. 1982;118:163–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Fowler Jr JF, Maibach HI, Taylor JS, DeKoven JG, Sasseville D, Warshaw EM, et al. Effects of immunomodulatory agents on patch testing: expert opinion 2012. Dermatitis. 2012;23:301–3.PubMedCrossRefGoogle Scholar
  33. 33.
    O’Quinn SE, Isbell KH. Influence of oral prednisone on eczematous patch test reactions. Arch Dermatol. 1969;99:380–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Feuerman E, Levy A. A study of the effect of prednisone and an antihistamine on patch test reactions. Br J Dermatol. 1972;86:68–71.PubMedCrossRefGoogle Scholar
  35. 35.
    Condie MW, Adams RM. Influence of oral prednisone on patch test reactions to Rhus antigen. Arch Dermatol. 1973;107:540–3.PubMedCrossRefGoogle Scholar
  36. 36.
    Olupona T, Scheinman P. Successful patch testing despite concomitant low-dose prednisone use. Dermatitis. 2008;19:117–8.PubMedGoogle Scholar
  37. 37.
    Anveden I, Lindberg M, Andersen KE, Bruze M, Isaksson M, Liden C, et al. Oral prednisone suppresses allergic but not irritant patch test reactions in individuals hypersensitive to nickel. Contact Dermatitis. 2004;50:298–303.PubMedCrossRefGoogle Scholar
  38. 38.
    Wee JS, White JML, McFadden JP, White IR. Patch testing in patients treated with systemic immunosuppression and cytokine inhibitors. Contact Dermatitis. 2010;62:165–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Rosmarin D, Gottlieb AB, Asarch A, Scheinman PL. Patch-testing while on systemic immunosuppressant’s. Dermatitis. 2009;20:265–70.PubMedGoogle Scholar
  40. 40.
    Bangsgaard N, Zachariae C, Menné T, Skov L. Lack of effect of ustekinumab in treatment of allergic contact dermatitis. Contact Dermatitis. 2011;65:227–30.PubMedCrossRefGoogle Scholar
  41. 41.
    Nosbaum A, Rozières A, Balme B, Goujon C, Nicolas JF, Bérard F. Blocking T helper 1/T helper 17 pathways has no effect on patch testing. Contact Dermatitis. 2013;68:58–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Cruz PD. Effects of UV light on the immune system: answer to five basic questions. Am J Contact Dermat. 1996;7:47–52.PubMedCrossRefGoogle Scholar
  43. 43.
    Lachapelle JM, Maibach HI. Patch testing methodology. In: Lachapelle JM, Maibach HI, editors. Patch testing and prick testing. 3rd ed. Berlin/Heidelberg: Springer; 2012. p. 35–77.CrossRefGoogle Scholar
  44. 44.
    Schwarz T, Schwarz A, Krone C, Luger TA. Pentoxifylline suppresses allergic patch test reactions in humans. Arch Dermatol. 1993;129:513–4.PubMedCrossRefGoogle Scholar
  45. 45.
    Balato N, Patruno C, Lembo G, Cuccurullo FM, Ayala F. Effect of pentoxifylline on patch test response. Contact Dermatitis. 1996;34:153.PubMedCrossRefGoogle Scholar
  46. 46.
    Collet E, Didier AF. Ce qu’il ne faut jamais faire en dermato-allergologie. In: Le Coz CJ, Jelen G, Lepoittevin JP, editors. Progrès en dermato-allergologie- Strasbourg 2003. Paris: John Libbey Eurotext; 2003. p. 153–9.Google Scholar
  47. 47.
    Lammintausta K, Maibach HI. Human cutaneous irritation: induced hyporeactivity. Contact Dermatitis. 1987;17:193–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Koehler AM, Maibach HI. Skin hyporeactivity in relation to patch testing. Contact Dermatitis. 2000;42:1–4.PubMedCrossRefGoogle Scholar
  49. 49.
    Beck MH. The patient with negative patch tests – what now? In: Guin JD, editor. Practical contact dermatitis. New York: McGraw-Hill Inc; 1995. p. 659–72.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Division of Dermatology, Department of MedicineMcGill University Health Centre, Royal Victoria HospitalMontréalCanada

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