Patch testing in Australia: Is it adequate?

BACKGROUND/OBJECTIVES: Patch testing (PT) is essential for making the diagnosis of allergic contact dermatitis (ACD). However, the extent of PT undertaken by Australian dermatologists is unknown. The objectives of this study were to determine the rate and type of PT in Australia, the perceived obstacles to PT, and to explore the exposure to PT in dermatology training.

METHODS: Data were collected on private PT (analysing Medicare item numbers) and public hospital-based PT (estimated via verbal reports). An online survey on PT was sent to Fellows of the Australasian College of Dermatologists.

RESULTS: It was found that total PT numbers, combining Medicare item number and public hospital data, were below the suggested optimum in all states and in Australia overall. Of the 173 respondents to the survey, 61% reported they patch tested and 78% reported they referred for PT. TrueTest was the most commonly used PT system, although it is known to be inadequate. Dermatologists who PT as registrars were significantly more likely to PT as consultants (P value = 0.0029). Cost, expertise required and staffing were considered major obstacles to performing PT. Accessibility and cost to the patient were common obstacles to referral.

CONCLUSIONS: The combination of suboptimal PT rates and inadequate PT means that patients are missing out on being diagnosed with ACD in Australia. Increasing the exposure of registrars to PT, supporting specialised centres, the development of the Australian Baseline Series and the Contact Allergen Bank will, it is hoped, improve the rates of comprehensive PT in Australia.