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Clinical Utilization of Repeated Open Application Test Among American Contact Dermatitis Society Members

Brown, Gabrielle E. MD, MS*; Botto, Nina MD; Butler, Daniel C. MD; Murase, Jenny E. MD†§

doi: 10.1097/DER.0000000000000132

Background The repeated open application test (ROAT) provides useful information regarding allergens in suspected cases of allergic contact dermatitis; however, standardized methodology has not been established.

Objective The aim of this study was to assess how ROAT is used in clinical and research settings.

Methods We distributed a survey regarding ROAT practice to the American Contact Dermatitis Society and conducted a literature review of ROAT utilization in research.

Results A total of 67 American Contact Dermatitis Society members participated in the survey. Respondents most frequently recommend application of leave-on products twice daily (46.0%) and rinse-off products once daily (43.5%). The most commonly used anatomical sites include the forearm (38.7%) and antecubital fossa (32.3%). Most respondents continue ROAT for 1 (49.2%) or 2 weeks (31.7%). Literature review of 32 studies (26 leave-on, 6 rinse-off) revealed that application frequency is most common at twice daily for both leave-on (96.2%) and rinse-off (50.0%) products. The most common anatomical site is the forearm (62.5%), with an overall study duration of 3 to 4 weeks (65.6%).

Conclusions When comparing ROAT clinical and research practice, the majority trend was consistent for leave-on product application frequency and anatomical site, but not for rinse-off product application frequency, or overall duration. Further research is needed to determine best practice recommendations.

From the *College of Medicine, University of Arizona, Tucson; †Department of Dermatology, University of California, San Francisco; ‡Department of Medicine, University of Arizona, Tucson; and §Palo Alto Foundation Medical Group, Mountain View, CA.

Address reprint requests to Jenny E. Murase, MD, Department of Dermatology, Palo Alto Foundation Medical Group, 701 E El Camino Real (31-104), Mountain View, CA 94040. E-mail:

The authors have no funding or conflicts of interest to declare.

© 2015 American Contact Dermatitis Society
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