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Patch Testing (102.035)

Patch Testing (102.035) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Dermatology

102.035

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: Patch Testing

Effective Date: October, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed Dec 2007 April, 2008 May 2009 November 2011


PURPOSE: To provide guidelines for Patch placement/reading at UWMF
Clinics.

DEFINITION: A Patch Test is used for
investigating contact dermatitis.

POLICY: The clinical staff will utilize the following guidelines to apply a
patch test.

Patients will return return at 48 hours for patch test removal and initial reading.
Delayed reading will be done at 96 hours, or up to 1 week after patch
application. Arrangements for patch test removal at home or in another
medical office may be made in certain cases.

SUPPLIES: Provider order, Patient record, Surgical (Scanpor) or Hypafix/Scanpor tape
Surgical Skin Marker or Sharpie fine pen, Education Handouts
Finn Chambers, Patch Test Reading Template, Patch Test Screening Form
T.R.U.E. patch or Chemotechnique patch test allergens (per provider)

PROCEDURE:
PATCH PLACEMENT

1. Check provider’s order and clarify any inconsistencies.

2. Wash hands and gather equipment.

3. Introduce yourself, identify the patient and provide privacy.

4. Explain procedure to the patient.

5. Put on gloves and apply prescribed T.R.U.E. patch test or other allergen patch, as recommended by
provider to the patient's upper back.

NOTE: Skin area should be clean, healthy and free of ointments or irritation. Men with a great amount of hair should
have their backs shaved prior to test. Shave in the direction of hair growth; not a “close” shave.)

 A tracing of the patch test sites and row number is outlined on the skin with a surgical skin marker or
Sharpie fine pen.
 Patients may also provide personal cosmetics, ointments, fabrics, materials or shoes which are suspected
allergens. Application of these materials brought in by the patient must be approved for patch test safety

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by the provider. In general, fabric or solid materials will be briefly soaked in water (10 min), squeezed
out and taped “as is” to the back with scanpore tape.
 Liquid materials provided by patients for patch testing may need to be diluted (per providers
instructions) with sterile water.
 Any additional patch tests will be given a test site number and the number and location will be recorded
on the Screening Form.

6. Take a photo of patient’s back with patch placement.

7. Apply Hypafix tape over the top of all patches. NOTE: Instruct patient to reinforce the tape if
necessary. Over the counter paper tape may also be used.

8. The test strips remain in place for 48 hours and are removed by the clinic staff at the patients return to
clinic. The patches are to be saved in the chart for the delayed reading.

9. Patients are given the following instructions:
Schedule a return to clinic appointment in two days for reading.
Keep the patch test sites dry until final delayed reading. Water, soap, lotion, moisturizers, etc. would
dilute or change the composition of the patch test substances thus affecting the outcome of the
reading. The pen marks must be preserved for accurate interpretation.
Limit activity to so as not to increase sweating to displace the chambers
Do not take any medication that could depress the immune system (i.e., prednisone, kenalog) during
the test week unless advised otherwise by provider.
No tanning or sun exposure on back during patch test week

10. A Patch Test Screening Form is labeled and placed in the patient record. Hold the record for the return
to clinic appointment for delayed reading.

11. When completed, wash hands.

12. Document in the patient’s record:
Date, time and location of Patch Test
Post care instructions given to the patient of family
Patient questions or concerns
Future appointments (48 hours/delayed reading).

48 HOUR PATCH READING

13. Hypafix tape removed with patches still in place.

14. A retracing of the patch test sites and plate number is outlined on the skin with a surgical skin marker or
Sharpie, then remove patches.

15. Patch test sites are read by the provider or clinical
staff no sooner than 20 minutes after removal.

16. Document reaction on the screening form
and on patient's 48-hour instruction card.




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NOTE: Reactions are graded at each reading as follows:
Weak positive reaction; red, bumpy. “1”
Strong + reaction; red, bumpy, blistery beyond patch site. “2”
Extreme positive reaction; bullous reaction/spreading reaction. “3”
Faint macular erythema only. “4”
Irritant reaction (like a sunburn or chemical burn). “5”
Negative reaction. “6”

DELAYED HOUR PATCH READING

17. The test sites are also checked for a delayed reaction.

18. For a positive reaction(s), patient education handouts are available for specific allergens. The physician
will review the handout with the patient.

19. Patients are instructed to observe for any sites, which are red, raised and blistered. Patients should call
with any delayed positive sites.

WRITTEN BY: Ronnie Peterson, R.N., M.S., Clinical Staff Educator

CONTRIBUTORS: Jodie Cook, Manager Dermatology
Anne O’Connell, C.M.A., Department of Dermatology

REVIEWED/REVISED BY: Lisa Hilker, CMA, Department of Dermatology, 2009

AUTHORIZATION:


Department of Dermatology Date


Medical Director Date