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I hv always had eczema problems around my fingers and mouth area. But lately it has gotten a lot worse and now my shin and calves, my arms, the palms of my hands and even chest area are starting to get many spots of eczema rash. I am very worried my whole body is going to get it. I hv seen professional dermatologists and find that they just dispense steriod creams. Why dont they recommend a patch test from the first consult? My friend told me to go back to them to ask for a patch test.
Thanks for the question. A patch test is recommended if there is suspicion of an allergic contact dermatitis. An allergic contact dermatitis is due to to the body’s reaction to substances applied to the skin which trigger an allergic reaction.
There can be other forms of contact dermatitis like irritant contact dermatitis which is due to irritation from the substances applied or in contact with the skin. A patch test is done for allergic contact dermatitis and not when irritant contact dermatitis is suspected.
A dermatologist would usually go through the history to determine the possible triggers. If there is a suspicion of an allergic contact dermatitis from the history, then a patch test would be indicated. If there is no suspicion from the history, then this may not be carried out as the yield of the investigation would be low. A patch test is not routinely done for all patients with eczema.
You can discuss this further with your dermatologist and ask him about doing a patch test for you condition. If needed, a patch test can be easily ordered.
Dr Colin Theng
First things first – you can certainly tell your dermatologist that you are keen on a patch test the next time you visit him, especially with your recent flare up. He will tell you why it is or isn’t indicated for your situation. But even so, the test needs to be done on clear skin, meaning you need to get your eczema under control first before the patch test can be carried out.
The reason why your doctor prescribed steroid cream is because that’s the correct treatment for your eczema. Even if you do a patch test, it will simply tell you what you need to avoid, but will not get rid of your ongoing active eczema.
As to the second part of your question – in a nutshell, patch tests are only performed in patients with eczema when a) you have a history strongly suggestive of a specific trigger for your eczema, or b) a trial of treatment for your eczema doesn’t work.
Patch tests are not done routinely for eczema because the results can be rather non-specific.
From your history alone, your doctor should be able to tell if there’s a specific trigger for your rash breakouts. He will then do a patch test to confirm it.
Conversely, if you’ve had a long history of atopic eczema, patch tests are unlikely to be helpful and may even produce “false positives”, ie results that indicate you are allergic to something that you actually aren’t allergic to!
I hope you get your eczema under control soon! I know what a pain it can be, as a former sufferer myself. I wrote some important things to note about eczema here.