PATIENT EDUCATION GUIDELINES

Patch Testing
Patch testing is a process used to determine what substances may be causing allergic reactions in
your skin. Your dermatologist will decide which substances to test. The goal of patch testing is to
reproduce the skin rash on a small, controlled area of the skin. The patch test will identify
materials, such as preservatives, fragrances, dyes, and chemicals that cause an allergic reaction
upon contact with your skin. Because patch testing does not break the skin barriers, allergies to
food, inhalants, and oral medication cannot be identified by this method.
WHAT TO EXPECT

During your initial visit, which lasts approximately 30 minutes, the nurse will apply one
or more small aluminum disks to an area on your upper back (used as the test site because
the strongest responses are seen in this area). These disks, or patch test kits, contain small
amounts of each suspected chemical or allergen; the substances to be tested are
determined by your dermatologist or other health care provider. A visible reaction in the
skin in contact with a disk indicates allergy to the substance contained in that disk. This
redness or rash may itch and persist for several days to several weeks.

You will be advised to return 48 hours later. At this time, the nurse will remove the
patches, mark your skin, and do the first reading; you will be expected to remain at the
office for 30 minutes so that the nurse can complete the reading.

A final reading will be done on your next visit, which will take place 96 hours after the
disks have been removed. A copy of your test results will be provided and explained to
you at this visit.

DO'S AND DON'TS

DO wear loose or high-necked clothing throughout the day. Hint: Wear a T-shirt to bed to
avoid catching the edges of the tape on the bed sheets.

DO apply tape to the patch edges if they become loose.

DO contact your health care provider immediately if a patch test area burns severely or if
you are unable to carry out normal daily activities. Note: Some itching will occur if you
are having a positive reaction; you do not need to call your dermatologist.

DO NOT wet the patches during the testing periodfor example, do not take showers.
Sponge baths are allowed as long as care is taken to keep the patches completely dry.

DO NOT engage in strenuous activities. Exercise may result in excess sweating, thereby
causing the tape to loosen.

DO NOT expose your back to the sun for 2 weeks before patch testing.

DO NOT discontinue antihistamine therapy (these agents do not affect test results).

DO NOT use nonmedicated creams and lotions on your back for at least 24 hours before
testing (lotions and creams prevent patches from sticking).

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OTHER TESTS
Patch Testing
Patch testing is an office procedure done in dermatology to determine if patients are allergic to
contact materials. Materials are applied in patches to the skin and checked for reaction 48 hours
after application and possibly again later. Erythema, swelling, papules, and vesicles indicate an
allergic contact dermatitis rather than an irritant contact dermatitis or no reaction.
See Patient Education Guidelines and Procedure Guidelines 33-1.
GENERAL PROCEDURES AND TREATMENT MODALITIES
BATHS AND WET DRESSINGS
A therapeutic bath is used to apply medication to the entire skin surface and is useful in treating
widespread eruptions and general pruritus. Baths soothe, soften, and reduce inflammation, and
relieve itching and dryness. See Table 33-1, page 1098, for types and desired effects. Wet
dressings and soaks are damp compresses that contain water, normal saline solution, aluminum
acetate solution, or magnesium sulfate solution. They may be sterile or clean, or warm or cool,
depending on the skin condition and the area to which they are applied.
TABLE 33-1 Therapeutic Baths
BATH SOLUTION AND MEDICATION DESIRED EFFECT
Water
Removes crusts and relieves inflammation
Saline

Used for widely disseminated lesions

Antipruritic and demulcent

Cooling

Soothing

Used for psoriasis and chronic

Colloidal
Oatmeal or Aveeno

Sodium bicarbonate

Starch

Tar baths
(follow package directions) Alma-Tar,
Balnetar, Lavatar, Polytar

eczematous conditions
Bath oils
Alpha Keri, Lubath, Nutraderm

Used for antipruritic and emollient

soothing properties

Used for acute and subacute eczematous

eruptions

THERAPEUTIC BATHS
Indications

Vesicular disorders, eczema, atopic dermatitis

Acute inflammatory conditions.

Erosions and exudative, crusted surfaces.

Nursing and Patient Care Considerations

Prepare the bath or teach the patient to prepare a lukewarm bath at 90 to 100 F
(32.2 to 37.8 C); with the tub half full, add the prescribed quantity of medication,
and mix thoroughly to prevent sensitivity reaction. Add Aveeno, Alpha Keri oils to
emulsifying baths

Do not rub the skin. Soaking for at least 5 to 10 minutes will promote removal of
loosened scales.

Keep the room and water at comfortable temperatures and limit bathing to 20 to 30
minutes; the bath area should be well ventilated if tars are used because they are volatile.
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P.1098

Tell the patient to use a bath mat inside the tub and to use a rug outside the tub when
bathing at home because medication may make the tub and wet surfaces slippery.

Blot skin dry with a towel and apply emollient or topical medication to moist skin, if
prescribed. While skin is wet, apply steroid to inflamed areas if prescribed.

PROCEDURE GUIDELINES 33-1

Patch Testing
PURPOSE
Patch testing is an essential diagnostic tool used to differentiate irritant versus allergic contact
dermatitis. Patients who present with dermatitis or eczema are potential candidates for patch
testing.
EQUIPMENT

Finn chambers (strips of 10 shallow aluminum cups or chambers 3 inches [8 cm] wide)

Allergens (2-inch [5-cm] ribbons of petrolatum-base allergen or disks with filter paper
dampened with aqueous solution). Standard tray includes:
o Benzocaine 5%
o Meraptobensothiasole 1%
o Colophony 20%
o p-Phenylenediamine 1%
o Imidazolidinyl urea 2%
o Cinnamic aldehyde 1%
o Lanolin alcohol 30%
o Carba mix 3%
o Neomycin sulfate 20%
o Thiuram mix 1%
o Formaldehyde 1%
o Ethylenediamine dihydrochloride 1%
o Epoxy resin 1%
o Quaternium-15 2%
o P-tert-Butylphenol formaldehyde resin 1%

o Mercapto mix 1%
o Black rubber mix 0.6%
o Potassium dichromate 0.25%
o Balsam of Peru
o Nickel sulfate
DRUG ALERT
Patients should not be taking oral corticosteroids at the time of the test; topical
corticosteroids should be discontinued 1 to 2 weeks before testing to prevent a weak reaction or
false-negative results. Make sure the patient has followed the health care provider's instructions.
PROCEDURE
Nursing Action
Rationale
1. Prepare Finn chambers with allergen. Aqueous
1.
allergens come in prefilled syringes that should be
kept refrigerated.
2. Apply strip to patient's back.
2.
a. Avoid hairy areas and areas affected by
a.Should be a large area of skin
dermatitis and sunburn.
unaffected by friction and free from
interfering skin lesions so that results
will be clear. Hair may interfere with
tape adhesion.
b. Preferred area is upper back.
b.Skin on upper back is most sensitive to
reaction.
3. Number the disks 1 through 10 to match the
3.To ensure that results are interpreted
allergen placed on the disk. If the patient is having correctly.
several strips applied, draw a diagram on the
patient's file to record which tray is placed in
which location.
4. Apply additional tape as required to keep patches 4.Sweating and activity may reduce
secure.
adherence in some people.
5. Instruct the patient to keep area dry, not to scratch 5.Area may become uncomfortable with
or remove the patches unless they become
positive reaction, but removal or
unbearable (severe burning, stinging, or pruritus). disruption of patch will invalidate results.
6. When patient returns in 48 hours for the first
6.Outline serves as a reference point to
reading, mark the outline of the patch strip on the interpret results.
patient's back, then remove the strip. A skin
marker or an ultraviolet skin pen marker may be
used.
7. Wait 30 minutes, then do the first reading.
7.The skin may be red from the application
Document as follows:
of the tape and a false reading may occur
if read too soon.
1 + Weak reaction. Nonvesicular, but with

erythema, induration, and possible papules

2 + Strong reaction. Edematous and vesicular,
with erythema, edema, papules, and vesicles
3 + Extreme reaction. Spreading, bullous,
ulcerative
IR Irritant reaction
Negative reaction
Not tested
Patches fell off
8. Instruct patient to keep the area dry after removal 8.Though the initial 48-hour reading may
of the patches and return again in 24 to 72 hours
be negative, positive results may be seen
(usually 48 hours) for additional reading.
at the 96-hour reading because of
delayed reaction.
9. A final reading is done on the last visit, results are
recorded, and counseling is given on negative or
positive results.
10 If the results are positive, the nurse discusses
. avoidance of allergens and gives the patient
written information regarding the allergens to be
avoided.