Patch testing in fixed drug eruptions: a 12‐year retrospective study

Calvão, Joana; Figueiredo, Carla; Gonçalo, Margarida

doi:10.1111/jdv.18290

Cited by 7 publications

(9 citation statements)

References 12 publications

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“…Conversely, we observed fewer relevant reactions to piroxicam, the photoallergen with the highest number of positive PPT reactions in our previous study 6 . This may be due to a change in prescription habits by Portuguese clinicians, as piroxicam has widely been replaced by coxibs which cause mostly fixed drug eruptions 20 …”

Section: Discussioncontrasting

confidence: 54%

“…6 This may be due to a change in prescription habits by Portuguese clinicians, as piroxicam has widely been replaced by coxibs which cause mostly fixed drug eruptions. 20 Phenothiazines were recommended to be included in the photopatch series of specific geographical regions. Promethazine, banned in other European countries, is still widely used as an antipruritic cream in Portugal and other Southern European countries.…”

Section: Photopatch Test Resultsmentioning

confidence: 99%

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Shedding a light on the importance of photopatch testing: A 12‐year experience in a dermatology unit

et al. 2023

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Background: Photopatch testing has been standardized for diagnosing photoallergic contact dermatitis but is still infrequently used.Objectives: To characterize photopatch test (PPT) results and their clinical relevance. Methods:We collected retrospective data from patients photopatch tested in our Dermatology Unit (2010-2021), using the European PPT 'baseline' series, other allergens, and patient's own products, when appropriate.Results: Out of 223 patients, 75 patients (33.6%) were reactive with 124 positive PPT reactions, considered relevant in 56/223 patients (25.1%) and in 72/124 reactions (58.1%). Most reactions were caused by topical drugs (n = 33; 45.8%), such as ketoprofen or promethazine, and 7 (9.8%) by systemic drugs, such as hydrochlorothiazide and fenofibrate. 'Classical' ultraviolet filters were responsible for six positive PPT reactions whereas there was only three relevant PPT to the 'newer' UV filters.Patients' sunscreens/cosmetics or plant extracts caused 10 positive PPT each.Additional patch test reactions were observed, mostly to Tinosorb ® M. Conclusion:Contrary to the trend in ACD, most positive PPT reactions were caused by topical drugs, outweighing ultraviolet filters and cosmetics. We stress the low reactivity to the 'newer' UV filters included in the PPT series. PPT was occasionally positive in systemic drug photosensitivity, but overall PPT reactivity was low.

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Section: Discussioncontrasting

confidence: 54%

Section: Photopatch Test Resultsmentioning

confidence: 99%

Shedding a light on the importance of photopatch testing: A 12‐year experience in a dermatology unit

et al. 2023

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“…To the best of our knowledge, so far there are nine case reports of FDE to this anti-H1, 2,4,5 and only two of those with positive patch tests to the three piperazine derivatives (hydroxyzine, cetirizine, and levocetirizine). 2,5 Despite the relative low sensitivity of lesional patch testing, which depends mostly on the culprit, 6,7 this is a safe procedure that allows simultaneous testing of many possible culprits and the study of cross-reactivity between drugs, 6 as in the present case. Therefore, lesional patch testing should be recommended before any attempt to perform oral drug provocation.…”

Section: Discussionmentioning

confidence: 86%

“…Despite the relative low sensitivity of lesional patch testing, which depends mostly on the culprit, 6,7 this is a safe procedure that allows simultaneous testing of many possible culprits and the study of cross‐reactivity between drugs, 6 as in the present case. Therefore, lesional patch testing should be recommended before any attempt to perform oral drug provocation.…”

Section: Discussionmentioning

confidence: 96%

A case of fixed drug eruption from cetirizine with cross‐reaction to levocetirizine and hydroxyzine

2022

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“…PTs are more frequently positive in MPE, DRESS, symmetrical drug-related intertriginous and flexural exanthema, AGEP and fixed drug eruption 20,35 , whereas they occur in < 10% in Stevens-Johnson syndrome/TEN (SJS/TEN) 9,36 . PT can also confirm cross-reactivity between drugs, namely between piroxicam and tenoxicam or between different piperazine antihistamines, 37,38 or absence of cross-reactivity, as for instance, between etoricoxib and celecoxib 39 or between meropenem and imipenem 40 . Moreover, PT reactivity can be evoked many years after the acute reaction 41 .…”

Section: Introductionmentioning

confidence: 99%

Positive drug patch tests and the acute cutaneous adverse drug reaction share many histopathologic features

Gonçalo¹,

Flor²,

Cardoso³

2023

PJDV

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Patch testing (PT) has been used to evaluate the culprit drug and cross-reactive chemicals in non-immediate cutaneous adverse drug reactions (CADR), but histopathology of patch tests is seldom performed. With the objective of characterizing the patterns of positive drugs patch tests in correlation with the acute skin reaction, we performed skin biopsies in 16 patients with different CADR, five cases of acute generalized exanthematous pustulosis (AGEP), six cases of maculopapular exanthema (MPE), four cases of drug reaction with eosinophilia and systemic symptoms (DRESS) and one case of toxic epidermal necrolysis (TEN). Particular macroscopic features of drug patch tests included pustules, particularly in AGEP, and epidermal necrosis in TEN and on histopathology, we highlight the occurrence of subcorneal spongiform pustules in AGEP, full-thickness epidermal necrolysis in the case of TEN and vacuolization of basal cells, lymphocyte exocytosis with occasional necrotic keratinocytes and a perivascular and interstitial lymphocyte infiltrate both in DRESS and MPE, although less intense in the latter. Similarities between the acute eruption and the patch test suggest the patch test can be considered a form of localized drug provocation test that can be used to further investigate the pathophysiology of CADR.

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Patch testing in fixed drug eruptions: a 12‐year retrospective study

Cited by 7 publications

References 12 publications

Shedding a light on the importance of photopatch testing: A 12‐year experience in a dermatology unit

Shedding a light on the importance of photopatch testing: A 12‐year experience in a dermatology unit

A case of fixed drug eruption from cetirizine with cross‐reaction to levocetirizine and hydroxyzine

Positive drug patch tests and the acute cutaneous adverse drug reaction share many histopathologic features

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