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Journal of the American Academy of Dermatology
Volume 80, n° 6
pages 1618-1629 (juin 2019)
Doi : 10.1016/j.jaad.2018.12.062
accepted : 27 December 2018
Original Articles

Patients with negative patch tests: Retrospective analysis of North American Contact Dermatitis Group (NACDG) data 2001-2016

Erin M. Warshaw, MD, MS a, b, Amy J. Zhang, BA c, , Donald V. Belsito, MD d, Joseph F. Fowler, MD e, James S. Taylor, MD f, Howard I. Maibach, MD g, Toby Mathias, MD h, Denis Sasseville, MD i, James G. Marks, MD j, Vincent A. DeLeo, MD k, Anthony F. Fransway, MD l, Kathryn A. Zug, MD m, Melanie D. Pratt, MD n, Matthew J. Zirwas, MD o, Joel G. DeKoven, MD p
a Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota 
b Department of Dermatology, University of Minnesota, Minneapolis, Minnesota 
c University of Minnesota Medical School, Minneapolis, Minnesota 
d Department of Dermatology, Columbia University, New York, New York 
e University of Louisville, Louisville, Kentucky 
f Department of Dermatology, Cleveland Clinic, Cleveland, Ohio 
g Department of Dermatology, University of California San Francisco, San Francisco, California 
h Department of Dermatology, University of Cincinnati, Cincinnati, Ohio 
i Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada 
j Department of Dermatology, Pennsylvania State University, State College, Pennsylvania 
k Department of Dermatology, Keck School of Medicine, Los Angeles, California 
l Associates in Dermatology, Fort Myers, Florida 
m Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 
n Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada 
o The Ohio State University, Columbus, Ohio 
p Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada 

Correspondence to: Amy Zhang, BA, Dept 111K 1 Veterans Dr, Minneapolis, MN 55417.Dept 111K 1 Veterans DrMinneapolisMN55417

Little is known regarding the characteristics of patients with negative patch test (NPT) results.


To characterize patients with NPT results.


Retrospective cross-sectional analysis of 34,822 patch tested patients. NPT results were defined as negative or irritant final interpretations of all North American Contact Dermatitis Group screening allergens and no relevant allergens on supplemental series.


Almost one-third of patients (n = 10,888 [31.3%]) had NPT results. Patients with NPT results were significantly more likely to be male (P  < .0001), be age 40 years or younger (P  = .0054), be nonwhite (P  = .0005), and have dermatitis primarily having a scattered generalized distribution (P  = .0007) or primarily located on the lips (P  = .0214) or eyelids (P  = .0364). However, the absolute differences in age, race, and site were small and may not be clinically meaningful. Patients with NPT results were significantly less likely to have occupationally related skin disease (P  < .0001). Overall, 8.3% of patients with NPT results had occupationally related skin disease, with precision production worker/machine operator (28.5%), health care worker (17.0%), and mechanic/repairer (7.5%) being the most commonly related occupations. In all, 22.9% of patients with NPT results had relevant irritants and 41.6% of irritants were occupationally related; cosmetics/health care products and soaps were common sources for both occupationally related and non–occupationally related irritants.


Retrospective cross-sectional study of tertiary referral population.


Patients with NPT results have distinct characteristics.

The full text of this article is available in PDF format.

Key words : irritants, occupational, patch testing

Abbreviations used : CI, ESSCA, NACDG, NPT, PPT, RR, TRUE Test

 Funding sources: None.
 Disclosure: Dr Taylor is a consultant for Johnson & Johnson, Bayer, Equinox Group, and Kao Brands and a stockholder for Johnson & Johnson, Express Scripts, Opko Health, and Astra Zeneca; in addition, he is an author for Decision Support in Medicine, and he has a nondependent child who is employed by Pfizer. Dr Zirwas is part owner of AsepticMD; a speaker, consultant, and investigator for Regeneron/Sanofi; a speaker for Genentech/Novartis; a consultant for Fit Bit, L'Oreal, and Menlo; and an investigator for Leo, Janssen, Incyte, Foamix, DS Biopharma, UCB, Pfizer, Lilly, Asana, and Avillion. Dr Warshaw, Mrs Zhang, Dr Mathias, Dr DeKoven, Dr Maibach, Dr Sasseville, Dr Belsito, Dr Fowler, Dr Zug, Dr Fransway, Dr DeLeo, Dr Marks, and Dr Pratt have no conflicts of interest to disclose.
 This material is the result of work supported with resources and the use of facilities at the Minneapolis Veterans Affairs Medical Center. The contents do not represent the views of the US Department of Veterans Affairs or the United States Government.
 Reprints not available from the authors.

© 2019  Published by Elsevier Masson SAS.
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