Should patch testing be restricted to dermatologists only

摘要: Calnan (1) wrote that "the greatest abuse of patchtesting is failure to use it" and "a number ofdermatologists have never patch tested a patient".However, equally or more serious than this maybe test incorrectly thus provide er-roneous conclusions (2).Patch testing is, at present, the only practicalscientific procedure for diagnosis allergiccontact dermatitis (3). The ease application ofthe can mislead unwary into overlookingthe fact biological assay witha pitfalls. Confidence in results canbe achieved when appropriate experience hasbeen gained indication test, its correctapplication, reading interpretation ofits results.Patch indicated allergic contactdermatitis suspected relevant allergenmust be identified confirmed. As objec-tive assessment any eczema, it may also serve toexclude contact sensitivity. Testing isnot substitute taking patient's history orexamination (4). It requires considerable dermatol-ogical even suspect allergy orcontact as an aggravating factor otherskin diseases. Allergic beimpossible differentiate clinically from otherforms such atopic, seborrhoeic, num-mular dyshidrotic these conditionsmay coexist. Taking re-quires time, knowledge potentialallergens patient might come into* On behalf Council European Society ofContact Dermatitis (W. Aberer, Austria; K. E. Andersen,Denmark; G. Angeiini, Italy; F. M. Brandao, Portugal;D. P. Bruynzeel, Netheriands; D. Burrows, NorthernIreland; J. Camarasa, Spain; Ducombs, France;P. Frosch, Germany; N. Hunziker, Switzerland; L.Kanerva, Finland; J.-M. Lachapelle, Belgium; E.Wahlberg, Sweden; Thune, Norway; I. R. White, Eng-land).contact with home, workplace duringleisure time. Changing consumer habits, produc-tion procedures, allergen prevalence geographicallyand temporally, other factors must con-sidered.The optimal choice materials theirapplication appear simple. Adequate infor-mation should given patients before applyingthe legal practical reasons. occur-rence irritant reactions, focal flare ofeczema, active sensitization rare side-effects need dealt appro-priately (3, 5). skin back preferredsite testing; free eczema andnot been recently exposed topical cortico-steroids UV-radiation. selection sub-stances based on andwill normally include current version the"standard series" (6). This series supple-mented those substances by pa-tient's exposure. standard de-tects 50-80% allergens.Only "standard" concentrations used;the potential risk industrial unknown toxieity kept mindand cautious.Test readings performed according tothe criteria ICDRG Negative, doubtful,positive are well-defined terms. Butthe "are absolutely no value thephysician confronted relatively weak reac-tion" (3); frequently case. criticalpoint evaluating positive response nothow severe but determination whetherit true caused non-specific reaction.Accurate most important: posi-tive reactions (allergic) false-positive (irritant), not present der-matitis, preceding and/or unrelatedproblem, primary cause