Impact of Anxiety on Patch Testing Results for Allergic Contact Dermatitis

Background: While patch testing remains the gold standard for diagnosis of allergic contact dermatitis (ACD), the reliability and reproducibility of patch testing results have been questioned in the literature. Various exogenous and endogenous factors have been explored as sources of discordance, but the effect of anxiety on patch testing results has not yet been studied. Anxiety is known to be associated with systemic inflammation and has been shown to increase the incidence of positive reactions in skin prick testing.Objective: This study aimed to investigate the impact of anxiety on patch testing results in patients with suspected ACD.Methods: Adult subjects (n = 35) presenting to an outpatient patch testing dermatology clinic completed 2 questionnaires on the day of patch placement: the State-Trait Anxiety Inventory (STAI-S) and the Generalized Anxiety Disorder-7 (GAD-7). All participants completed patch testing with the North American Contact Dermatitis Group 80 series. Patches were removed after 48 hours, and a final reading was performed after 120 hours.Results: No meaningful correlations were found between the incidence of all positive reactions (±, +, ++, and +++) and participants' STAI-S scores (Pearson's r = -0.036) or GAD-7 scores (Pearson's r = 0.1). Weak negative correlations were identified between the incidence of strong positive reactions (++ and +++) and participants' STAI-S scores (Pearson's r = -0.2) and GAD-7 scores (Pearson's r = -0.2).Conclusions: The results of this study suggest that anxiety does not have an impact on patch testing results for patients with suspected ACD. Future studies would benefit from having a larger sample size and greater gender and racial diversity within the study population.