The skin pathergy test: innately useful?

Abstract

Pathergy is the term used to describe hyper-reactivity of the skin that occurs in response to minimal trauma. A positive skin pathergy test (SPT), characterised by erythematous induration at the site of the needle stick with a small pustule containing sterile pus at its centre, is among the criteria required for a diagnosis of Behçet's disease (BD) and in certain population has been shown to be highly specific for this condition. Problems with standardising the induction manoeuvre for the SPT as well as the method of assessment of the response have limited the usefulness of the SPT in the clinical setting. Extensive investigation into histopathological and immunological aspects of pathergy has led to a number of hypotheses relating to the aetiology of the skin pathergy reaction and the disease itself, but the cause is considered to be unknown. Pathergy lesions, the development of new skin lesions or the aggravation of existing ones following trivial trauma, are also reported in pyoderma gangrenosum and has been noted in other neutrophilic dermatoses such as Sweet's syndrome. The response of such patient groups to the systematic application of the SPT has not been described. We propose that a new way of considering the pathergy reaction is to see it as an aberration of the skin's innate reactivity from a homeostatic reactive mode closely coupled to tissue healing to an abnormal destructive/inflammatory mode. Our understanding of BD and other similar conditions would profit by more detailed mechanistic knowledge of skin homeostasis to minimal trauma in both health and disease through a more structured and systematic use of the SPT.

HLA-B51 subtypes in Turkish patients with Behçet's disease and their correlation with clinical manifestations

“…The GUs were more frequent in the female patients, which is consistent with an earlier study, in which the clinical findings of 2313 patients were analyzed (Tursen et al, 2003). The frequency of pathergy positivity in patients living in Mediterranean countries (84-98%) was suggested to be higher than the patients living in Far East (40-70%) (Lee et al, 1997;Alpsoy et al, 1998;Varol et al, 2010). The pathergy test was positive in 74.5% of our patients, which is higher than the results of other authors (56.1%) (Tursen et al, 2003;Alpsoy et al, 2007).…”

“…It is believed to be strongly related to a genetic predisposition, depending on its frequency in a specific geographical area, its close relationship with HLA-B51 in different ethnic groups, and familial distribution. HLA-B51gene positivity is frequently seen in areas where Turkish tribes immigrated along the Silk Road, which seems to support the genetic influence (Azizlerli et al, 2003, Papoutsis et al, 2006Varol et al, 2010;Hamzaoui et al, 2012 …”

Are Cutaneous Microdialysis Cytokine Findings Supported by End Point Biopsy Immunohistochemistry Findings?

“…Even common disease entities like psoriasis and atopic eczema are widely considered to reflect varying innate reactivity levels (43)(44)(45)(46)(47). A more uncommon example of variant reactivity to minimal trauma in disease is the pathergy reaction to minimal trauma seen in Behçet's disease and some other inflammatory diseases (48). Whilst insertion of a microdialysis catheter is more complicated than necessary for the directed study of reactivity to minimal trauma (49), it should be noted that CMD can be viewed as involving a similar minimal skin trauma-but with dermal reactivity isolated from epidermal reactivity.…”

Pathergy test

“…Daha sonra Katzenellenbogen paterji fenomenini daha detaylı olarak gözden geçirmiştir 3 . Klinik olarak pozitif paterji testi derinin iğne batırılan yerinde ortaya çıkan, merkezinde minik steril bir püstül bulunabilen eritematöz indurasyon ile karakterizedir 4 . Paterji testi pozitifliği, BH dışında piyoderma gangrenozum, Sweet sendromu ve eritema elevatum diutinum gibi nötrofilik dermatozlarda görülebilmekle birlikte bu hastalıklarda rutin olarak paterji testi yapılmamaktadır 4 .…”