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Epicutaneous tests

Epicutaneous testing is a test that can diagnose allergic contact dermatitis and identify specific allergens that can trigger the disease.

Indications

  • Persistent skin rash with suspected contact allergy
  • Any chronic inflammation of the skin, especially if the feet and toes, eyelids or face are affected.
  • Exematous dermatitis in people working in occupations with a high risk of dermatitis (health care workers, cosmetologists, machinists or people working with rubber and plastic).
  • Skin inflammation of unknown cause
  • Previously stable skin inflammation worsening
  • Differentiation of allergic contact dermatitis from irritant, atopic, seborrhoeic and stasis dermatitis, nummular and astatotic eczema and psoriasis.

Contraindications

  • Rash on the skin of the back
  • Heavily tanned skin
  • Pregnancy and breast-feeding (tests have not been found to harm the foetus or the mother, but it is preferable to postpone tests in this case as a general precaution).
  • Treatment with systemic corticosteroids and cytostatic drugs. Treatment with antihistamines, ibuprofen and analogue drugs such as adalimumab, etanercept, ustekinumab and infliximab may continue.

Preparing for the survey

As certain factors may affect the outcome of the survey, it is important to know the following:

  • 2 to 4 weeks must have elapsed since the skin inflammation flared up in the area where the test was performed.
  • A minimum of 4 weeks must have passed since the intensive tanning.
  • 2 weeks must have elapsed since the use of corticosteroid ointments in the test area.
  • It is advisable to take a shower on the morning of the study day.
  • Do not use skin care products in the test area on the morning of the test day.
  • If the back is hairy, the upper back must be shaved 2 days before the tests are done.

Carrying out the survey

During the study, you will need to visit the clinic three days a week (Monday, Wednesday and Friday). At the first visit, the allergens will be applied to your upper back using patches, where they will remain for 48 hours.
You will need to see a nurse for a second visit to have the patches removed and the results of the epicutaneous tests assessed. At the third visit, the doctor will make a final assessment of the tests.

During the study period, i.e. for five days:

  • Refrain from active activities that cause perspiration (exercise, sauna, hard physical work) and thus cause the patches to peel off the skin.
  • Avoid back tanning and light therapy

You may feel moderate itching and discomfort in the test area. If the itching is very severe, you can remove the patch yourself. Make sure the patches are properly adhered to the skin. If the edges of the patch come loose, secure them with an additional patch.

Possible side effects

Epicutaneous tests are mostly safe and do not cause serious allergic reactions. Some side effects may occur:

  • Hypersensitivity to patch or chamber material
  • Skin irritation
  • Exacerbation of an existing rash, irritated skin or “angry back syndrome” (a strong positive result makes the skin hyper-reactive so that a positive reaction occurs in many other allergen areas that would otherwise remain negative).
  • Pressure effect from the edges of the chamber pressing against the skin (disappears within 15-30 minutes after patch removal).
  • Pigmentation or depigmentation
  • Militias
  • Sustained positive reaction over a longer period of time
  • Koebner phenomenon (in psoriasis and flat muscle)

If any of the side effects worsen, contact your doctor or go to the emergency department.

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