Pathergy test: Difference between revisions
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The '''pathergy test''', is a non-specific [[skin]] reaction to trauma that is observed in patients with [[Behçet disease]]. This reaction is classified as a [[hypersensitivity]] reaction. The positive pathergy test is one of the minor [[diagnostic]] criteria of [[Behçet disease|Behçet’s disease]]. | The '''pathergy test''', is a non-specific [[skin]] reaction to trauma that is observed in patients with [[Behçet disease]]. This reaction is classified as a [[hypersensitivity]] reaction. The positive pathergy test is one of the minor [[diagnostic]] criteria of [[Behçet disease|Behçet’s disease]]. | ||
==Procedure== | ==Procedure== | ||
There is no standardized method for performing the pathergy test.<ref name="BakerSmith2011">{{cite journal|last1=Baker|first1=M. R.|last2=Smith|first2=E. V.|last3=Seidi|first3=O. A.|title=Pathergy test|journal=Practical Neurology|volume=11|issue=5|year=2011|pages=301–302|issn=1474-7758|doi=10.1136/practneurol-2011-000072}}</ref><ref name="OzdenBek2010">{{cite journal|last1=Ozden|first1=MG|last2=Bek|first2=Y|last3=Aydin|first3=F|last4=Senturk|first4=N|last5=Canturk|first5=T|last6=Turanli|first6=AY|title=Different application techniques of pathergy testing among dermatologists|journal=Journal of the European Academy of Dermatology and Venereology|volume=24|issue=10|year=2010|pages=1240–1242|issn=09269959|doi=10.1111/j.1468-3083.2010.03622.x}}</ref> | '''Skin Pathergy test'''<br> | ||
'''Procedure | There is no standardized method for performing the pathergy test. However, the method below is one of the suggested ways.<ref name="BakerSmith2011">{{cite journal|last1=Baker|first1=M. R.|last2=Smith|first2=E. V.|last3=Seidi|first3=O. A.|title=Pathergy test|journal=Practical Neurology|volume=11|issue=5|year=2011|pages=301–302|issn=1474-7758|doi=10.1136/practneurol-2011-000072}}</ref><ref name="OzdenBek2010">{{cite journal|last1=Ozden|first1=MG|last2=Bek|first2=Y|last3=Aydin|first3=F|last4=Senturk|first4=N|last5=Canturk|first5=T|last6=Turanli|first6=AY|title=Different application techniques of pathergy testing among dermatologists|journal=Journal of the European Academy of Dermatology and Venereology|volume=24|issue=10|year=2010|pages=1240–1242|issn=09269959|doi=10.1111/j.1468-3083.2010.03622.x}}</ref><br> | ||
'''Procedure'''<br> | |||
The area of the [[skin]] should not be cleaned with [[Disinfectants|disinfectant]] and the [[needle]] should be blunted against the inside surface of its [[sterile]] plastic sheath before using. The [[needle]] is inserted carefully at an angle of 30° to the [[skin]] into the [[dermis]] at a depth of 1.5–2 mm. The [[needle]] should not be observed beneath the [[epidermis]] and then it should be withdrawn with a twisting movement. The [[test]] is read between 24 to 48 hours after the procedure. One of the suggested scales for the degree of positivity is a three-point scale as follows: | |||
* '''Negative Result:''' only [[needle]] mark (scored 0) | * '''Negative Result:''' only [[needle]] mark (scored 0) | ||
* '''Positive Result:''' the presence of papule or pustule | * '''Positive Result:''' the presence of papule or pustule | ||
** 1+ [[papule]] only | ** 1+ [[papule]] only | ||
** 2+ [[Pustules|pustule]] | ** 2+ [[Pustules|pustule]] | ||
Another scale for the interpretation of the [[test]] is indicated in the table below:<ref name="SharquieAl-Araji2002">{{cite journal|last1=Sharquie|first1=K.E.|last2=Al-Araji|first2=A.|last3=Hatem|first3=A.|title=Oral pathergy test in Behçet's disease|journal=British Journal of Dermatology|volume=146|issue=1|year=2002|pages=168–169|issn=00070963|doi=10.1046/j.1365-2133.2002.4513_5.x}}</ref> | Another scale for the interpretation of the [[test]], known as '''Dilsen pathergy test'', is indicated in the table below:<ref name="SharquieAl-Araji2002">{{cite journal|last1=Sharquie|first1=K.E.|last2=Al-Araji|first2=A.|last3=Hatem|first3=A.|title=Oral pathergy test in Behçet's disease|journal=British Journal of Dermatology|volume=146|issue=1|year=2002|pages=168–169|issn=00070963|doi=10.1046/j.1365-2133.2002.4513_5.x}}</ref> | ||
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To increase the [[sensitivity]] of the test: | To increase the [[sensitivity]] of the test: | ||
* make at least two [[needle]] pricks on the glabrous [[skin]] of the forearm | * make at least two [[needle]] pricks on the glabrous [[skin]] of the forearm | ||
* Use a large [[hypodermic]] needle (21 | * Use a large [[hypodermic]] needle (21 gauge or less) | ||
* Use four [[needle]] pricks in total | * Use four [[needle]] pricks in total | ||
'''Oral pathergy test''' | '''Oral pathergy test'''<br> | ||
To perform the test, a 20-gauge (0.9 mm) blunt disposable needle is used to prick the mucous membrane of the lower lip to the submucosa. The test is then read 48 hours later. The result is interpreted as below:<ref name="SharquieAl-Araji2002">{{cite journal|last1=Sharquie|first1=K.E.|last2=Al-Araji|first2=A.|last3=Hatem|first3=A.|title=Oral pathergy test in Behçet's disease|journal=British Journal of Dermatology|volume=146|issue=1|year=2002|pages=168–169|issn=00070963|doi=10.1046/j.1365-2133.2002.4513_5.x}}</ref> | |||
* '''Positive Result:''' Presence of pustule and/or ulcer | |||
* '''Negative Result:''' Absence of aformentioned lesions | |||
This method is more accessible than the traditional skin test, as there is no need to measure the size of the lesion and pustule or ulcer of any size turn the test positive.<br> | |||
* Additionally, it has similar sensitivity to Dilsen skin pathergy test. | |||
==Associated Conditions== | ==Associated Conditions== | ||
The following [[disorders]] are [[Association (statistics)|associated]] with positive pathergy test:<ref name="BakerSmith2011">{{cite journal|last1=Baker|first1=M. R.|last2=Smith|first2=E. V.|last3=Seidi|first3=O. A.|title=Pathergy test|journal=Practical Neurology|volume=11|issue=5|year=2011|pages=301–302|issn=1474-7758|doi=10.1136/practneurol-2011-000072}}</ref> | The following [[disorders]] are [[Association (statistics)|associated]] with positive pathergy test:<ref name="BakerSmith2011">{{cite journal|last1=Baker|first1=M. R.|last2=Smith|first2=E. V.|last3=Seidi|first3=O. A.|title=Pathergy test|journal=Practical Neurology|volume=11|issue=5|year=2011|pages=301–302|issn=1474-7758|doi=10.1136/practneurol-2011-000072}}</ref> | ||
| Line 50: | Line 56: | ||
* [[Chronic myeloid leukemia]] treated with [[Interferon-alpha|interferon α]] | * [[Chronic myeloid leukemia]] treated with [[Interferon-alpha|interferon α]] | ||
* [[Inflammatory bowel disease]] | * [[Inflammatory bowel disease]] | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 14:00, 31 July 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]
Overview
The pathergy test, is a non-specific skin reaction to trauma that is observed in patients with Behçet disease. This reaction is classified as a hypersensitivity reaction. The positive pathergy test is one of the minor diagnostic criteria of Behçet’s disease.
Procedure
Skin Pathergy test
There is no standardized method for performing the pathergy test. However, the method below is one of the suggested ways.[1][2]
Procedure
The area of the skin should not be cleaned with disinfectant and the needle should be blunted against the inside surface of its sterile plastic sheath before using. The needle is inserted carefully at an angle of 30° to the skin into the dermis at a depth of 1.5–2 mm. The needle should not be observed beneath the epidermis and then it should be withdrawn with a twisting movement. The test is read between 24 to 48 hours after the procedure. One of the suggested scales for the degree of positivity is a three-point scale as follows:
- Negative Result: only needle mark (scored 0)
- Positive Result: the presence of papule or pustule
Another scale for the interpretation of the test, known as 'Dilsen pathergy test, is indicated in the table below:[3]
| Test result | Clinical characteristic of the test at 48 h |
| Negative result | Only erythema <2 mm |
| Undetermined | Only erythema >3 mm or papule 1-2 mm + erythema <2 mm |
| Positive result | 1+ Papule 2-3 mm + erythema >3 mm |
| 2+ Papule >3 mm + erythema >3 mm | |
| 3+ Pustule 1-2 mm + erythema >3 mm | |
| 4+ Pustule >2 mm + erythema >3 mm |
To increase the sensitivity of the test:
- make at least two needle pricks on the glabrous skin of the forearm
- Use a large hypodermic needle (21 gauge or less)
- Use four needle pricks in total
Oral pathergy test
To perform the test, a 20-gauge (0.9 mm) blunt disposable needle is used to prick the mucous membrane of the lower lip to the submucosa. The test is then read 48 hours later. The result is interpreted as below:[3]
- Positive Result: Presence of pustule and/or ulcer
- Negative Result: Absence of aformentioned lesions
This method is more accessible than the traditional skin test, as there is no need to measure the size of the lesion and pustule or ulcer of any size turn the test positive.
- Additionally, it has similar sensitivity to Dilsen skin pathergy test.
Associated Conditions
The following disorders are associated with positive pathergy test:[1]
- Behçet’s disease
- Pyoderma gangernosum
- Sweet’s syndrome
- Atypical eosinophilic pustular folliculitis
- Neonates with Down syndrome
- Myeloproliferative disorders
- Non-Hodgkin’s lymphoma
- Chronic myeloid leukemia treated with interferon α
- Inflammatory bowel disease
References
- ↑ 1.0 1.1 Baker, M. R.; Smith, E. V.; Seidi, O. A. (2011). "Pathergy test". Practical Neurology. 11 (5): 301–302. doi:10.1136/practneurol-2011-000072. ISSN 1474-7758.
- ↑ Ozden, MG; Bek, Y; Aydin, F; Senturk, N; Canturk, T; Turanli, AY (2010). "Different application techniques of pathergy testing among dermatologists". Journal of the European Academy of Dermatology and Venereology. 24 (10): 1240–1242. doi:10.1111/j.1468-3083.2010.03622.x. ISSN 0926-9959.
- ↑ 3.0 3.1 Sharquie, K.E.; Al-Araji, A.; Hatem, A. (2002). "Oral pathergy test in Behçet's disease". British Journal of Dermatology. 146 (1): 168–169. doi:10.1046/j.1365-2133.2002.4513_5.x. ISSN 0007-0963.