Pathergy test

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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]

Synonyms and keywords:

Overview

• The pathergy test, is a non-specific skin reaction to trauma that is observed in patients with Behçet’s 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

• There is no standardized method for performing the pathergy test.
• To increase the sensitivity of the test:
  • making at least two needle pricks on the glabrous skin of the forearm5
  • Using a large hypodermic needle (21 g or less)
  • Using four needle pricks in total
• Proccedure: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 The needle should not be observed beneath the epidermis and then it should be withdrawn with a twisting movement.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.
  • 1+ papule only
  • 2+ pustule

Associated Conditions

• The following disorders are associated with positive pathergy test:
  • Behçet’s disease
  • Pyoderma gangernosum
  • Sweet’s syndrome
  • Atypical eosinophilic pustular folliculitis
  • Neonates with Down’s syndrome
  • Myeloproliferative disorders
  • Non-Hodgkin’s lymphoma
  • Chronic myeloid leukemia treated with interferon α
  • Inflammatory bowel disease