Patch-Testing While on Systemic Immunosuppressants

Background: Occasionally, the need arises to patch-test patients while they are on immunomodulators. Little is known about how these systemic agents affect the results of patch testing. Objective: To present data on 11 patients who underwent patch testing while under the effects of immunosuppressants. Methods: Retrospective chart reviews were performed on 11 patients who underwent patch testing while they were taking various systemic immunosuppressants or within 48 hours of cessation of various systemic immunosuppressants. Results: Patients had been taking prednisone (n = 6), cyclosporine (n = 2), combination cyclosporine and prednisone (n = 1), mycophenolate mofetil (n = 1), and infliximab (n = 1) up to 48 hours prior to and/or during patch testing. Seven patients showed at least one strong (++) or extreme (+++) patch-test reaction. Three patients had at least one weak (+) reaction. One patient showed only questionable reactions. The patient on mycophenolate was eventually retested while off immunosuppressants; and showed strong clinically relevant patch-test reactions. Overall, 8 of the 11 patients reported some improvement in their dermatitis, including all the patients with strong or extreme reactions. Conclusion: While it is optimal for patch testing to be performed when patients are off immunosuppressants, immunosuppressive therapies should not be an absolute contraindication to patch testing.