Pruebas de Parche.

The Medical Necessity of Comprehensive Patch Testing

Dermatitis: Official Journal of the American Contact Dermatitis Society, North American Contact Dermatitis Group

TAKE-HOME MESSAGE

• Allergen identification is crucial in the management of allergic contact dermatitis (ACD). The commercially available T.R.U.E Test screening panel (36 allergens) is reported to have a detection rate of, at most, 66.0% of the clinically relevant reactions identified by the North American Contact Dermatitis Group (NACDG). Notably, up to 50% of allergens causing occupational dermatitis are missed. Studies show that 21% to 34% of ACD diagnoses would be missed by the NACDG screening series without the use of supplemental allergens. Comprehensive testing with supplemental allergens beyond a screening series may increase the diagnostic yield and the likelihood of achieving a cure for ACD.

• The authors emphasize the need to integrate the patient's medical history, examination findings, and environmental exposure history to implement comprehensive and customized allergen testing in the management of ACD.

 Dermatology

Written by

 

 

Salma F de la Feld MD, FAAD

Contact dermatitis has a significant impact on patients' quality of life and, as the fifth most prevalent skin disease in the United States, it has a high burden of medical cost at over $1 billion. This article highlights the importance of utilizing comprehensive patch testing to effectively diagnose and cure patients of allergic contact dermatitis. Although "limited" patch testing with 36 allergens can seem easier, it misses up to one-third of the diagnoses found on comprehensive patch testing and misses up to 50% of the causes of occupational dermatitis. The time involved with this labor-intensive, 1-week procedure can be a barrier to utilization. However, in the long-run, proper accurate diagnosis and counseling with patch testing can avert subsequent office visits and additional unnecessary treatment (decreasing the economic impact of this disease) as well as ultimately improving patients' quality of life.

Comprehensive patch testing is an underutilized and helpful tool that should be considered in the evaluation and treatment of allergic contact dermatitis. Patients will often come in saying that they already had "allergy testing" and not realize that they actually had prick or intradermal testing instead, which evaluates for different diseases (such as immediate, IgE-mediated type I hypersensitivities). Patch testing evaluates for delayed-type hypersensitivity and allergic contact dermatitis, and it is important to make this distinction when approaching patients.