The quantification of patch test responses: a comparison between echographic and colorimetric methods.

Patch testing is widely used both for clinical and experimental purposes. Although the clinical grading employed routinely is of practical value, the lack of objectivity makes it unsuitable for research purposes and dose-response analysis studies. Instrumental measuring techniques have been applied to patch test evaluation, because they enable objective quantification of different biophysical aspects of the inflammatory reaction by means of a continuous assessment scale, providing data suitable for statistical analysis. In order to compare the colorimetric and echographic methods for the evaluation of reactions of different intensity, we performed patch tests with 5% nickel sulfate on the flexor aspect of the forearm in 120 nickel-sensitive patients. Clinical and instrumental measurements were performed at 72 h. Numerical values corresponding to instrumental measurements were compared to the positivity degree, as assessed clinically. Whereas echographic parameters, expressing the intensity of oedema and inflammatory infiltration, enabled a distinction between +, +2 and +3 reactions, colorimetric a* values, describing erythema, failed to distinguish between +2 and +3 reactions. Thus, the use of ultrasound is advisable for the quantification of skin reactions of great intensity, whereas the colorimetric method could be usefully employed for dose-response studies assessing minimal eliciting concentrations of allergens, and for the evaluation of clinically undetectable reactions.