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Patch Testing and Immunosuppression: a Comprehensive Review

  • Contact Dermatitis (Brandon Adler and Vincent Deleo, Section editors)
  • Published:
Current Dermatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To provide an up-to-date synthesis of the literature on patch testing (PT) in patients undergoing immunosuppressive therapy or experiencing certain immunosuppressive diseases.

Recent Findings

With respect to immunosuppressive drugs, there is a risk of false-negative reactions if PT is conducted on patients taking prednisone at a dose greater than 10 mg daily. Topical corticosteroids, particularly high-potency formulations, could suppress positive reactions if applied to the test area in the days before PT. Other conventional systemic immunosuppressants have the potential to induce false-negative reactions in a dose-dependent manner, based on low-quality evidence. Dupilumab may carry a risk of suppressing positive reactions depending on each allergen’s immunologic signature, but existing studies show mixed results regarding this hypothesis. PT should be avoided following significant ultraviolet light exposure, but the ideal waiting time is unknown.

For patients with HIV, sarcoidosis, or leprosy, there is a lack of research establishing the extent to which these disease states could impact the accuracy of PT.

Summary

For the most part, knowledge of the effects of immunosuppressive drugs and disease states on PT is based on small, retrospective studies. Given the prevalence of allergic contact dermatitis and numerous causes of immunosuppression, there is a need for high-quality studies investigating the impact of immunosuppression on PT in order to standardize practice and allow clinicians and patients to make the best-informed decisions possible.

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Authors and Affiliations

  1. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Brandon Levian & Justin Chan

  2. Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Vincent A. DeLeo & Brandon L. Adler

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Levian, B., Chan, J., DeLeo, V.A. et al. Patch Testing and Immunosuppression: a Comprehensive Review. Curr Derm Rep 10, 128–139 (2021). https://doi.org/10.1007/s13671-021-00346-1

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