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The Medical Necessity of Comprehensive Patch Testing

Zhu, Tian, Hao, MD*; Suresh, Raagini, BS; Warshaw, Erin, MD‡§; Scheinman, Pamela, MD; Mowad, Christen, MD; Botto, Nina, MD**; Brod, Bruce, MD††; Taylor, James, S., MD‡‡; Atwater, Amber, Reck, MD§§; Watsky, Kalman, MD∥∥; Schalock, Peter, C., MD¶¶; Machler, Brian, C., MD***; Helms, Stephen, MD†††; Jacob, Sharon, E., MD‡‡‡; Murase, Jenny, E., MD**§§§

doi: 10.1097/DER.0000000000000362
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Allergic contact dermatitis is associated with significant disease and economic burden in the United States. To properly manage allergic contact dermatitis, it is important to accurately identify the substance(s) implicated in the dermatitis to prevent disease recurrence. The commercially available T.R.U.E Test (36 allergens) screening panel has been reported to have a conservative hypothetical allergen detection rate of 66.0%, at most. Importantly, these calculations are based on the 78% of patients who had clinically relevant reactions to allergens present on the North American Contact Dermatitis Group screening series (70 allergens), without the use of supplemental allergens. Testing with supplemental allergens beyond a screening series can more fully evaluate an individual's environmental and occupational exposure, which may significantly increase diagnostic accuracy. Comprehensive patch testing with additional allergens in sunscreens, cosmetics, and fragrances, for example, may increase the diagnostic yield as well as the likelihood of achieving a cure if the dermatitis is chronic and recalcitrant.

From the *University of Southern California Keck School of Medicine, Los Angeles;

University of California, San Francisco, School of Medicine;

Department of Dermatology, University of Minnesota School of Medicine, Minneapolis VA Medical Center;

§Park Nicollet, Minneapolis, MN;

Department of Dermatology, Brigham and Women's Hospital, Boston, MA;

Department of Dermatology, Geisinger Medical Center, Danville, PA;

**Department of Dermatology, University of California, San Francisco;

††Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia;

‡‡Department of Dermatology, Cleveland Clinic, OH;

§§Department of Dermatology, Duke University Medical Center, Durham, NC;

∥∥Department of Dermatology, Yale School of Medicine, New Haven, CT;

¶¶Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH;

***Department of Dermatology, New York University School of Medicine;

†††Department of Dermatology, University of Mississippi Medical School, Jackson; and

‡‡‡Department of Dermatology, Loma Linda University Medical Center; and

§§§Department of Dermatology, 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: jemurase@gmail.com.

A.R.A. is a past consultant for Intraderm Pharmaceuticals and a lecturer for Med Ed Solutions, LCC. S.E.J. is founder and chief executive officer of the Dermatitis Academy Website, a consultant for Johnson and Johnson, and an independent investigator for the PREA safety and efficacy trials on the T.R.U.E. Test. B.C.M. is a speaker for Pfizer. P.S. is a consultant for Squire Patton Boggs law firm, a lecturer for BWH Allergy Department, and an author for UptoDate. K.W. is a board member of Yale-New Haven Hospital and an author of the UptoDate section on Prurigo Nodularis. J.S.T. has been a consultant for Johnson & Johnson and Kao Brands and received royalty payments from Decision Support in Medicine. He is a stockholder in Express Scripts, Opko Health, Johnson & Johnson, Merck, AstraZeneca, and Allergan.

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

© 2018 American Contact Dermatitis Society
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