Patch testing for contact dermatitis

What is allergic contact dermatitis?

This is a condition where you develop patches of inflammation on your skin (called dermatitis) when your skin reacts against a specific substance. In this type of contact dermatitis, the patches of skin are itchy, red, and scaly. They may also blister. The substance you react to is called an allergen. You are not born with this type of allergy - you must have previously come into contact with the allergen which has 'turned on' your immune system. Your skin then comes out with a rash when it comes into further contact. See the separate leaflet called Contact Dermatitis.

Another type of dermatitis is called atopic dermatitis, or eczema. This is longer lasting and tends to start in childhood.

What is patch testing?

If you know what you are allergic to then you don't need further tests: just do your best to avoid whatever it is. However, some people develop symptoms of contact dermatitis and the cause is not clear. Metals, cosmetics, creams, leather and rubber contain lots of chemicals and only one of them might be responsible. So it gets very hard indeed to work out what is causing the allergic dermatitis without an allergy test. Patch testing may help to identify the exact cause. It is not a foolproof test to find every cause of dermatitis, but it often helps.

How is patch testing done?

Patch testing is almost always carried out by a skin specialist (a dermatologist). You will see one in a clinic and explain your symptoms. They will examine you. If they agree that the cause of your rash is likely to be due to allergic contact dermatitis, they may arrange for you to come back to the skin department for patch testing:

• On day one of testing, tiny amounts of up to 25 or more allergens are applied as small patches to your skin. This is usually on your upper back. They are fixed on with non-allergic tape.

• After two days you return to the department and the patches are removed. The skin is examined to see if there is a reaction to any of the tested substances.

• After a further two days the skin is examined again in case you have a delayed reaction to any substance.

Which substances are tested in a patch test?

There is a standard set of the most common type of substances which cause allergic contact dermatitis. These include:

• Balsam of Peru.

• Benzocaine.

• Chrome.

• Clioquinol.

• Cobalt.

• Epoxy resin.

• Ethylenediamine.

• Formaldehyde.

• Fragrances.

• Imidazolidinyl urea.

• Neomycin.

• Nickel.

• Paraben mix.

• Paraphenylenediamine.

• Plants.

• P-tert butylphenol.

• Formaldehyde resin.

• Quaternium-15.

• Rosin.

• Rubber accelerators.

• Wool alcohols (lanolin).

You may not recognise many of these, but they are common additives to ointments, clothes, leathers and other everyday materials.

Also, if other allergens are suspected, your skin specialist may add in other patches. For example, chemicals found in your workplace, or your own cosmetics. You may be asked to bring in small samples of these things to be added to the set of patches.

Tell your doctor if you suspect that the cause of the rash is something you were in contact with when the rash first appeared. This can often be tested.

The test results

If you have a reaction to any of the substances, the skin specialist will be able to tell you what it is, and what materials contain that substance. They will give you advice on how to avoid that substance. Avoiding the substance should prevent any further flare-ups of the rash. If no skin reaction occurs on patch testing then this can also be helpful to rule out allergic contact dermatitis as a cause of your skin problem.

Some other points about patch testing

• Patch testing only tests for allergic contact dermatitis. It does not diagnose other types of allergy such as food allergy or urticaria.

• Keep the area of skin being tested dry until the final skin examination - which is usually four days after the patches are put on the skin.

• While patch testing is in progress, avoid activities that cause you to sweat a lot.

• Patch tests are not the same as skin prick tests which are sometimes used to diagnose other types of allergy.

• Patch testing cannot find the cause of atopic eczema.

• Keep sunlight and other sources of ultraviolet (UV) light off the skin being tested. So keep a shirt on when outdoors for the duration of the test.

Photo-patch testing

In some people, certain substances cause an allergic reaction in the skin only if they are exposed to and triggered by sunlight (photocontact dermatitis). Usually the UV light in sunlight is responsible. This may be suspected if your rash only appears on areas of skin exposed to light, such as the face, neck and back of hands.

With photo-patch testing, two identical sets of substances are put on to your skin, as described above. One set is exposed to some UV light. The skin is examined in the usual way (after two and four days) and this may identify skin reactions to a substance only when it is exposed to light.