Clinics and Referrals
Recommendations before a patient is referred to for patch testing:
Often there can be a wait period before a patient can be seen in the occupational or general contact dermatitis clinic, this wait time may be a week or two or sometimes several months. If you require an urgent appointment, please let the patch testing team know, and the patient can be placed on the cancellation list.
Whilst waiting for an appointment there are some recommended actions a treating practitioner should consider for a person with dermatitis including:
1/ Topical corticosteroids may be needed
Ensure a sufficient quantity has been prescribed, think about the package size of cortisone cream/ointment, for example is it enough to cover feet and legs for an extended period. Also consider cost of this for the patient.
Ointments are generally preferred to creams, as they are more effective and do not contain preservatives.
2/ Recommend a good moisturiser
Recommend a fragrance-free cream or ointment (in a tub or tube).
If occlusion of hands is required, suggest cotton gloves rather than vinyl or latex (these can cause sweating) or cling wrap.
Apply topical cortisone first, allow to sink in and then apply the moisturiser.
3/ Use mild skin care cleansers
Recommend a fragrance free, mild hand cleanser or soap substitute. Use at home and work (if possible).
4/ Encourage patient to reduce amounts of wet work performed where possible.
Can someone else bath the children or do the dishes?
Can an alcohol-based hand rub be used for when the hands are not visibly dirty?
4/ Ensure patient is not using products that contain the preservative Methylisothiazolinone (MI)
Check to see if they are using baby wipes, plus check their moisturiser, shampoo, deodorant, sunscreen, hand and body washes, as MI is appearing in many household products
5/ Ask the patient to trial avoiding all fragranced products.
Stop using hand wash, body wash, shampoo and conditioner that contain fragrances. Trial this for a few weeks to see if there is any improvement. Words that may indicate fragrances are added are:
Fragrance, parfum or perfume, linalool, limonene etc.
6/ If wearing rubber or latex gloves – do a RAST blood test checking for latex allergy.
If latex allergy is diagnosed, the patient can stop using latex products before their patch testing appointment. Remember some dishwashing style rubber gloves can contain latex.
Latex allergy can be excluded before patch testing, and is an easy thing to address, and may help the skin to improve if this is the problem.
Here is a link to some useful information for the referring dermatologist to give to the patient when considering a referral which includes information on the process and costs. INSERT LINK
Contact clinic
This clinic is for people with general cases of contact dermatitis, for example people with rashes caused by make-up or sunscreen and issues with hair dye.
Occupational clinic
The occupational clinic is for people with suspected contact dermatitis related to their occupation. Occupational groups often seen include healthcare workers, hairdressers, cleaners, mechanics and construction workers and anyone who is frequently exposed to irritants and allergens.
Referrals
Doctors can send referrals for the patch testing clinics by completing an online form at
or via email: [email protected]
Please note, once we receive the referral, please allow 7 days for nurses to triage the referral and contact the patient. Our team works Monday, Wednesday and Fridays. Messages can be left on our voicemail, and we will return the call when we are next in the office.
Please ensure all referrals have a patient phone number and email address. Once we triage the patient, we email the patch testing information, consent forms and costings directly to the patient. These MUST be returned before an appointment is made.
All patients are required to pay a $450 deposit at time of making an appointment. A patient will forfeit this deposit if they cancel their appointment with 10 days of their appointment date.
Patch testing and medications (including biologics)
There is often confusion about whether a person can or can’t be tested on certain medications and biologic drugs. Some medications can reduce the size of patch test reactions or sometimes stop reactions occurring entirely. Meaning the patch test results cannot always be reliable.
Research indicates that patch testing can be done in most situations, but if possible, testing before starting a biologic drug is recommended, or have the biggest gap possible between injection and patch testing. When patch testing on upacitinib (Rinvoq) stop on the Friday before testing (if patch testing starts on the Monday). There is not a lot of data available on these drugs and how they impact patch testing results. We know some drugs diminish or reduce the strength of the reactions, possibly leading to false negative reactions
Oral corticosteroids should ideally be ceased at least 48 hours before testing. On rare occasions, those with severe dermatitis or eczema may have to continue on a small dose (5-10mg maximum) to ensure the skin is maintained at a level where patch testing is possible. The dermatologist conducting the patch testing should be aware that the patient is taking oral steroids. This should also be noted when reactions are being read as the strength of reactions may be reduced.
Medications such as methotrexate, azathioprine and cyclosporine may be continued during the patch testing process, as long as the dermatologist is aware of this.
Other medications such as antibiotics can also be taken during the patch testing process, as they do not impact on patch testing results.
Topical corticosteroids may be continued, except on the back during the period of testing. If applying on an area where patches are to be applied, topical steroid use should be ceased 3-7 days beforehand. If ceased closer to the period of testing, be mindful of false negative reactions.
Antihistamines may be used as they will not affect test results. However, they can impact prick testing results.
Patch testing on rashy or eczematous skin is generally discouraged, as patch testing on such skin can cause a flare up, therefore making reading of results difficult
We would recommend avoiding applying patches on areas of skin that have an active rash and to consider patch testing once the skin has improved
Occasionally a patient with severe eczema or dermatitis will be patch tested whilst on a low dose of oral corticosteroids, particularly if there is a risk that skin will deteriorate if they are stopped. However, be aware that reactions may be lessened as a result
Be cautious when applying patches to skin with recent eczema or very dry skin. Some patches can stick too firmly and be difficult to remove.
At SHI, we avoid patch testing in the first and second trimester of pregnancy, because the side effects of patch testing on the baby are unknown
Patch testing in the 3rd trimester can occur, if absolutely necessary. Otherwise, its preferable to wait until the baby is born
On the other hand, some believe that patch testing in pregnancy should not be performed despite a lack of evidence suggesting that allergens used during testing could pass through to the foetus.
Patch testing a breastfeeding mother is considered to be safe.
There should be no sun exposure or phototherapy to the back for a minimum of 7 days prior to testing. Theoretically sunlight exposure before testing may reduce the immune response of the skin (and therefore affect the test results), although clearcut evidence is lacking. A patient should not attend patch testing with sunburn.
Patch testing in the 3rd trimester can occur, if absolutely necessary. Otherwise, its preferable to wait until the baby is born
On the other hand, some believe that patch testing in pregnancy should not be performed despite a lack of evidence suggesting that allergens used during testing could pass through to the foetus.
Patch testing a breastfeeding mother is considered to be safe.