Angry back or the excited skin syndrome

Bruynzeel, Derk P.; Ketel, W. G. van; Flier, Mary von Blomberg-van der; Scheper, R.J.

doi:10.1016/s0190-9622(83)70044-7

Cited by 70 publications

(20 citation statements)

References 15 publications

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“…Strong reactions induce a state of hyperirrita bility. also designated as excited skin syndrome [32], To reduce the possibility of false-negative test reactions it may be emphasized that the test material for the detection of contact allergy to Kathon CG should include the cosmetic products in question, so that the reaction products of isothiazolinones are also tested for allergic reactions. A fur ther reduction of false-negative reactions is obtained by testing with an allergen-mix containing Kathon CG.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Frequency of Contact Allergic Reactions to Kathon CG in the Maastricht Area – 1987–1990

Lucker¹,

Hulsmans²,

Kley³

et al. 1992

Dermatology

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Frequency of Contact Allergic Reactions to Kathon CG in the Maastricht Area – 1987–1990

Lucker¹,

Hulsmans²,

Kley³

et al. 1992

Dermatology

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“…There is also the possibility that false-positive reactions appear due to the excited skin syndrome [Maibach, 1981;Mitchell and Maibach, 1997;Mitchell, 1975;Bruynzeel et al, 1983]. The likelihood of this occurring can be reduced by carrying out patch tests in a timephased manner so that the number of patches is minimized.…”

Section: Can We Rule Out 'Excited Skin'?mentioning

confidence: 99%

“…Over 40% of such positive patch reactions are lost on re-patching [Mitchell, 1975;Bruynzeel et al, 1983;Mitchell and Maibach, 1997]. Indeed, some studies have involved phased patch testing schedules to avoid false-positive results due to this syndrome.…”

mentioning

confidence: 99%

Operational Definition of a Causative Contact Allergen – A Study with Six Fragrance Allergens

Hostýnek¹,

Maibach²

2003

Exog Dermatol

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In practice, the clinical diagnosis of allergic contact dermatitis is often highly problematic with the identification of the specific allergen that has actually caused a patient’s particular dermatitic episode being even more difficult. A large number of reports in the literature are able to identify a number of substances to which the patient is allergic without clearly indicating a causal link to the patient’s current problem. For the reader of such reports, it is often difficult to judge if this link has been established, and for this reason, a number of criteria have been proposed to determine if reported positive patch test reactions are clinically relevant. These criteria include the degree of information given on the selection and condition of the patients, patch testing conditions, the intensity and duration of reactions, reactions occurring simultaneously to other patch test materials, the likelihood of confounding factors such as cross-reactions and excited skin occurring, linkage to specific consumer products or environmental sources of the putative allergen and follow-up with appropriate use testing. Criteria are also suggested for evaluating a substance’s allergenic potency from reports of predictive testing. These include the availability of details on the test methodology, maximization procedures, the selection criteria for test and control subjects and of the exact test scores. The applicability of these criteria are tested in separate publications on 6 fragrance allergens, for which information is provided on patch test concentrations.

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“…Whenever the clinical history of a patient suggested strongly that either one of these common allergens may produce a positive reaction, he placed the nickel or dichromate on the patient's arm away from the other patches and thus avoided the "crazy back". Spillover was observed clinically (4,23,28,34,35) and experimentally (36) in eczema patients but could not be demonstrated in non-eczematous subjects (18,37). A zone of hyperirritability was demonstrated around a positive patch test reaction (38) but positive TRUE Test™ reactions to higher doses of nickel sulfate did not enhance adjacent patch test reactions (19) to lower doses of nickel.…”

Section: Spillovermentioning

confidence: 99%

Managing the excited skin syndrome: patch testing hyperirritable skin

Mitchell¹,

Maibach²

1997

Contact Dermatitis

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Inflammation-modulating phenomena (IMPs), humoral and cellular, fluctuate during the course of irritant and allergic contact dermatitis influencing irritability of the skin. The patch test procedure is a biological assay, a titration of responses to IMPs which can produce hyporeactivity or hyperirritability of the skin of patients who have dermatitis (PDs) and a single patch test is a 'snapshot' of the tempo of an evolving process. The excited skin syndrome (ESS) refers to hyperirritability from clinical and patch test dermatitis creating false-positive patch test reactions which are not reproducible when dermatitis and IMPs have subsided. During ESS, the threshold for irritancy decreases and irritant reactions increase. Patch test concentrations should be determined and ESS investigated in PDs having enhanced IMPs, not in 'normal' individuals, and if a patch test result is important to a patient the test should be performed more than once. Variable reproducibility is inherent in the patch test method, but ESS can be managed by appropriate testing and retesting, and search for relevance.

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Angry back or the excited skin syndrome

Cited by 70 publications

References 15 publications

Evaluation of the Frequency of Contact Allergic Reactions to Kathon CG in the Maastricht Area – 1987–1990

Evaluation of the Frequency of Contact Allergic Reactions to Kathon CG in the Maastricht Area – 1987–1990

Operational Definition of a Causative Contact Allergen – A Study with Six Fragrance Allergens

Managing the excited skin syndrome: patch testing hyperirritable skin

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