Factors Associated With Irritant Reactions on Epicutaneous Patch Testing

Allergic and irritant reactions on patch testing can be difficult to differentiate clinically. We aim to identify factors associated with irritant reactions and correlate skin barrier function, measured in the form of transepidermal water loss (TEWL).

Consecutive patients undergoing patch testing at a tertiary hospital dermatology department were included. Primary demographic data were collected along with the results of patch testing and clinical confidence scores. TEWL was measured on the volar forearm using a Tewameter TM Hex skin probe at the Day 2 reading.

Sixty-six participants from March 2022 to June 2023 were analysed. The median age was 41 years, with participants having at least one irritant reaction being significantly older (p = 0.03). Seventy-nine percent (%) were female, and 47% had atopic dermatitis. Seventeen participants (26%) had irritant reactions recorded on the final patch test reading. The median TEWL in participants with irritant reactions was 21.03 g/h/m², compared with 13.11 g/h/m² in participants without (p = 0.09). Clinical confidence scores for irritant patch reactions were generally lower than for positive patch reactions.

Apart from age, there were no significant correlations between demographic or clinical factors such as atopic dermatitis and TEWL, with irritant reactions. Further research is required with a larger sample size to ascertain if TEWL may be a useful adjunct to improve confidence in interpreting irritant patch test reactions.