AAD 2019 recomendaciones de Fármacos inmunomoduladores y pruebas de Parche... Patch Testing: Pearls for the Referring Practitioner (U003) Ari M. Goldminz, MD

Can immunosuppressants be used during patch testing? Patch testing can be done while patients are on immunosuppressants.

• Ideally patients would be off immunosuppressants during testing and for some time beforehand. But in reality...

  o Some patients are unlikely to come off immunosuppressants. Examples: Transplant patients or patients with severe, widespread dermatitis

  o Some patients will flare off immunosuppressants and the ability to place patches may be limited

• General recommendations are to avoid (Fowler et al 2012):

  o Topical corticosteroids to patch test sites for 3-7 days (Experts divided evenly between 3 and 7 days) o UV-treatment/significant sun exposure at patch test site for 0-2 weeks (Consensus: 1 week)
  o Prednisone for 1-14 days (Consensus: 3-5 days)

  § Prednisone 10-20 mg by mouth daily is okay (Consensus: 10 mg, but discontinue if possible) o Triamcinolone 40 mg IM for 3-4 weeks (Consensus: 4 weeks)
  o Azathioprine, cyclosporine, mycophenolate mofetil, tacrolimus have a dose-dependent inhibition o Methotrexate, TNF inhibitors, ustekinumab unknown to little/no effect (Consensus)