Actas Dermosifiliogr.

2020;111(8):650---654

CONSENSUS DOCUMENT

Patch Testing During the COVID-19 Pandemic:

Recommendations of the AEDV’s Spanish Contact
Dermatitis and Skin Allergy Research Group (GEIDAC)夽
J.M. Carrascosa,a,∗ M.A. Pastor-Nieto,b I. Ruiz-González,c J.F. Silvestre,d
L. Borrego,e M.E. Gatica-Ortega,f A.M. Giménez-Arnaug , on behalf of Grupo Español de
Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC)夽
a
Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona,
Spain
b
Servicio de Dermatología, Hospital Universitario de Guadalajara, Guadalajara, Spain
c
Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain
d
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
e
Servicio de Dermatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
f
Servicio de Dermatología, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
g
Servicio de Dermatología, Parc de Salut Mar, Barcelona, Spain
Received 9 June 2020; accepted 13 June 2020

KEYWORDS Abstract As the COVID-19 pandemic gradually comes under control, the members of the Span-
Dermatitis; ish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) have drawn up a proposed list
COVID-19; of the requirements, limitations, and conditioning factors affecting the resumption of work in
Patch testing; contact dermatitis units. The assumption is that the severe acute respiratory syndrome coron-
Telemedicine; avirus 2 is still circulating and that occasional or seasonal outbreaks will occur. They recommend
Contact that the first step should be to assess how many patch tests each clinic can handle and review
the waiting list to prioritize cases according to disease severity and urgency. Digital technolo-
gies can, where possible, be used to send and receive the documentation necessary for the
patch test (information, instructions, informed consent, etc.). If the necessary infrastructure
is available, patients can be offered the option of a remote initial consultation. Likewise, in
selected cases, the patch test results can be read in a virtual visit using photographs taken by
the patient or a video visit can be scheduled to allow the physician to evaluate the site of appli-
cation remotely. These measures will reduce the number of face-to-face visits required, but
will not affect the time spent on each case, which must be scheduled in the normal manner. All
of these recommendations are suggestions and should be adapted to the needs and possibilities
of each health centre.
© 2020 Published by Elsevier España, S.L.U. on behalf of AEDV. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
夽 Please cite this article as: Carrascosa JM, Pastor-Nieto MA, Ruiz-González I, Silvestre JF, Borrego L, Gatica-Ortega ME, et al. Recomenda-

ciones del Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) de la AEDV en relación con la realización
de pruebas epicutáneas durante la pandemia por SARS-CoV-2 (COVID-19). Actas Dermosifiliogr. 2020;111:650---654.
♦ on behalf of Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC)
∗ Corresponding author.

E-mail address: [email protected] (J.M. Carrascosa).

1 Appendix A lists all the components of the Spanish Research Group on Contact Dermatitis and Skin Allergy (GEIDAC).

1578-2190/© 2020 Published by Elsevier España, S.L.U. on behalf of AEDV. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

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 Recommendations of the AEDV’s Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) 651

PALABRAS CLAVE Recomendaciones del Grupo Español de Investigación en Dermatitis de Contacto y

Dermatitis; Alergia Cutánea (GEIDAC) de la AEDV en relación con la realización de pruebas
COVID-19; epicutáneas durante la pandemia por SARS-CoV-2 (COVID-19)
Epicutáneas;
Resumen Con el progresivo control de la pandemia por SARS-CoV-2, los miembros del Grupo
Telemedicina;
Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) realizan una
Contacto
propuesta sobre cuáles van a ser los requisitos, las limitaciones y los condicionantes para
reanudar el servicio en las unidades de dermatitis de contacto en un escenario en el que se
presume la persistencia del virus, con episodios ocasionales o estacionales de exacerbación. Se
aconseja ajustar el número de pruebas epicutáneas (PE) a las posibilidades de cada centro y la
revisión de los casos en lista de espera para priorizar a los pacientes en función de la gravedad
y la urgencia. Se ofrecerán, si es factible, métodos telemáticos para los documentos relativos
a las PE (información, pautas, documentos de consentimiento informado). De estar disponible,
puede ofrecerse la opción de realizar una primera visita telemática. Igualmente, en pacientes
seleccionados puede llevarse a cabo una televisita en las visitas de lectura a través de imágenes
realizadas por el paciente o mediante una videovisita que permita visualizar el resultado de la
exploración. Estas acciones permitirán reducir el número de visitas presenciales, aunque no el
tiempo dedicado y asignado al facultativo para los actos médicos. Todas estas recomendaciones
son sugerencias y se adaptarán a los requisitos y a las posibilidades de cada centro sanitario.
© 2020 Publicado por Elsevier España, S.L.U. en nombre de AEDV. Este es un artı́culo Open
Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The rapid spread of infection by the coronavirus SARS- appointments (e.g., 1 patient per hour, 5-6 patients per
CoV-2 and the disease associated with this virus (COVID-19) week). Consequently, it may be advisable to restrict the
constitute a serious public health problem.1 indication for patch testing to those cases where it is likely
The SARS-CoV-2 pandemic has led to the suspension of to have greater diagnostic yield, at least until the risk of
most contact dermatitis units and patch testing services infection has decreased.
because of the need for hospitals to prioritize treatment • The waiting list should be reviewed in order to priori-
of COVID-19.2,3 tize patients depending on disease severity and urgency.
As the pandemic is gradually coming under control, we Appendix B provides a detailed list of conditions that
must now consider the requirements, limitations, and con- should be prioritized, although the attending physician’s
ditioning factors affecting resumption of work in contact evaluation should prevail in each case.
dermatitis units in a scenario in which the virus is still circu- • Alternatively, the patient should be given the option of
lating and occasional or seasonal exacerbation episodes are postponing patch testing, especially in high-risk cases
possible. (elderly patients or patients with risk conditions for COVID
The risk of spread of SARS-CoV-2 in contact dermatitis [cardiovascular disease, diabetes, arterial hypertension,
units is unknown, although common areas in these units fol- obesity, chronic respiratory disease, liver disease, cancer,
low similar disinfection protocols to those of other hospital and immunosuppression]). Similarly, and based on medical
services. However, in contact dermatitis units, which gener- criteria, patch testing can be postponed in patients with
ally have specific consulting rooms with constant movement mild or moderate eczema at sites not considered a prior-
of physicians and nurses, contact with patients is closer and ity and not active in recent months or with little impact
longer over time, with several visits in a few days. This close on quality of life.
contact entails specific problems with respect to safety and • If feasible, we can provide the patient with scanned
the spread of SARS-CoV-2 between health professionals and copies of all the necessary documentation relating to
between patients and health professionals. the tests (information, regimens, informed consent doc-
With the aim of balancing the risks and benefits for uments) by e-mail and receive the documents signed via
patients and optimizing safety for staff in charge of patient the same channel. The e-mail should be official and not
visits and diagnostic tests, the Spanish Contact Dermatitis sent as an individual message from the patch testing
and Skin Allergy Research Group (GEIDAC) of the Spanish team.
Academy of Dermatology and Venereology has drawn up the • If available, the first visit can be virtual in the case of
following recommendations: patch testing indicated by an external physician or physi-
cian other than the attending physician at the contact
dermatitis unit. In this case, patch testing should be pre-
• The number of patch tests should be adapted to the pos- ceded by an online visit, with or without images and/or
sibilities of the individual center based on relevant safety video. Thus, based on the individual clinical history, this
factors. In other words, a reasonable number of patients approach would make it possible to prioritize patients
should be scheduled depending on their specific charac- whose diagnosis would be optimized with patch testing.
teristics and on other simultaneous consultations in order Patients can provide information for the history, com-
to avoid crowding in the waiting room or overlapping

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 652 J.M. Carrascosa et al.

plete a questionnaire (e.g., history of atopy, occupational Appendix A. Members of the Spanish Contact
details, and contact allergens), send photographs of the Dermatitis and Skin Allergy Research Group
lesions and of their own products (and of the ingredients (GEIDAC)
in the case of personal care products) or of the summary
of product characteristics in the case of occupational
José Carlos Armario Hita (Cádiz), Leopoldo Borrego Her-
contact allergens.
nando (Las Palmas de Gran Canaria), José Manuel Carrascosa
• During the days before patch testing, patients should
Carrillo (Barcelona), Susana Córdoba Guijarro (Madrid),
be contacted by telephone to ensure that they or the
Laia Curto (Barcelona), Virginia Fernández Redondo (San-
people they live with or the people they have been in
tiago de Compostela), Ignasi Figueras Nart (Barcelona),
recent contact with do not have symptoms of COVID-
Juan García Gavín (Pontevedra), María Elena Gatica Ortega
19. The symptoms to be asked about are shown in a
(Toledo), Anna Giménez Arnau (Barcelona), Elena Giménez
questionnaire (Appendix C). Testing will be postponed
Arnau (Barcelona), Enrique Gómez de la Fuente (Madrid),
in the case of patients who have tested positive for
Ricardo González Pérez (Álava), Felipe Heras Mendaza
COVID-19. These patients should then be referred to their
(Madrid), Marcos Hervella Garcés (Pamplona), Pilar Man-
health center in order to adhere to the protocols estab-
rique Martínez (Vizcaya), Pedro Mercader García (Murcia),
lished for each center and region. Similarly, before each
Francisco Javier Ortiz de Frutos (Madrid), Javier Miquel
face-to-face visit, patients must be asked about signs
Miquel (Valencia), María Antonia Pastor Nieto (Guadala-
or symptoms that are suggestive of COVID-19 (question-
jara), Mercedes Rodríguez Serna (Valencia), Inmaculada Ruíz
naire in Appendix B). When COVID-19 is suspected, patch
González (León), Araceli Sánchez Gilo (Madrid), Paloma
testing should be postponed until the infection can be
Sánchez-Pedreño Guillén (Murcia), Javier Sánchez Pérez
confirmed or ruled out. Given that some patients may not
(Madrid), Tatiana Sanz Sánchez (Madrid), Esther Serra-
have symptoms or a detectable viral load before devel-
Baldrich (Barcelona), Juan Francisco Silvestre Salvador
oping symptoms, the absence of the symptoms should
(Alicante), Violeta Zaragoza Ninet (Valencia).
not lead us to neglect general safety measures. In the
case of patients who present with signs or symptoms
that are suggestive of COVID-19 after performance of Appendix B. Conditions for Which Patch
patch testing and before the reading, priority will be Testing Should Be Prioritized
given to virtual methods of reading and interpretation.
If this is not possible, and depending on the individual • Occupational eczema.
situation, patch testing can be postponed or the reading • Severe eczema.
performed in a specific area for patients who are positive • Eczema of the face or hands and widespread eczema that
for COVID-19 and using appropriate personal protective does not respond to appropriate treatment or protection
equipment. Patients should receive specific recommen- measures.
dations, preferably before patch testing (Appendix D). • Acute recurrent eczema of unknown origin.
• The procedures followed for patch testing should be • Patients in whom dermatitis progresses with a high impact
adapted to appropriate safety requirements for the SARS- on quality-of-life.
CoV-2 pandemic (Appendix E). • Patients who are to undergo a surgical or therapeutic
• Visit for reading/interpretation of patch test results (48- intervention that cannot be delayed and for which the
96 h). The first reading should be taken immediately after results of patch testing are essential (drugs, medical
removal of the patches. In equivocal cases, we should wait devices, glucose sensors/insulin pumps, dental interven-
half an hour following the previously established safety tion, orthopedic intervention, patients who are atopic
recommendations. In specific cases, we can turn to tele- before systemic therapy).
dermatology, which enables patients to send images they
themselves have taken. Similarly, a video consultation
will enable us to visualize the outcome of the exam- Appendix C. COVID Symptoms Questionnaire
ination, provide an interpretation, and record results
in the clinical history, with recommendations for the During the last 14 days, have you experienced any of the
patient. At this visit, we should calculate the time nec- following symptoms?
essary to resolve doubts and send all the documentation
(e.g., report, avoidance measures, treatment, and new • Fever.
appointments). • Cough.
• These actions will make it possible to reduce the num- • Difficulty breathing.
ber of in-person visits, although not the time taken by • Muscle pain.
and assigned to the physician for medical procedures. This • Tiredness.
may be even longer, given the need for a strict protocol • Impairment or loss of sense of taste or a bitter taste with
and additional requirements. In other words, quality and food and water.
detail should be preferred over quantity. • Reduced sense of smell or loss of sense of smell.
• These procedures should be based on circuits that • Diarrhea.
guarantee the confidentiality and reliability of digitally
transmitted data. If you notice any of the symptoms, please call us and we
• All of these recommendations are suggestions, which can will decide what to do. However, in principle, it would be
be adapted to the requirements and possibilities of the best if you did not come to the hospital.
individual health center.

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 Recommendations of the AEDV’s Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) 653

During the week you undergo testing, you should take 15 We will give you the information about your next
your temperature every day and ensure that you do not have appointment by telephone or by e-mail. Wherever pos-
any of the symptoms mentioned above. Please contact us if sible, we will try to keep your appointment at the same
you notice any symptoms. time throughout the week of patch testing.
16 When you return home from hospital on the days of your
tests you must take the following precautions (and in
Appendix D. Information for Patients the following order):
a Leave items such as bags and papers at the entrance.
1 Before coming to the center, please re-read the informa- b Remove your shoes and leave them at the entrance.
tion on tests that we gave you when you came to your c Wash your hands with soap and water for 1 minute.
first visit or that you were sent by e-mail. d Remove your mask.
2 Please keep to the time of your appointment. If you e Remove your clothes.
arrive early, please wait in the car. You must not arrive late. f Wash carefully and try to keep the test area dry (use
We are trying to avoid crowding in the waiting rooms. a handheld shower, clean other areas and wash your
We would be grateful if you would help by arriving at hair separately in the sink).
the allotted time. g Wash clothes in the washing machine at 60◦ .
3 Do not forget to bring your own products (shower gel, h Disinfect objects or materials that are likely to carry
creams, and products for your skin condition). Please infection (e.g., phone, keys, bag) with alcohol.
bring these in their original container. i Finally, wash your hands again very carefully.
4 Your own products will be placed in a clean bag and can
be left in the hospital until testing is complete. You can
also bring them and take them home again, although You should follow these steps every time you return from
they must be here at each visit. the hospital.
5 You are recommended to bring the signed informed con-
sent document (you can send this by e-mail as a scanned
document if this option is available at your center).
Alternatively, you can sign the informed consent doc- Appendix E. Instructions for Staff Who
ument during your first visit. Perform Patch Testing: Suggestions That
6 Please go to the toilet before leaving home so that you Should Be Adapted to Local Requirements
do not to have to do so in the hospital.
7 Please try to bring as few personal objects as possible • Organize the appointments list in order to avoid the accu-
(bag, fan, umbrella). If possible, try to make sure that mulation of patients in the waiting room.
these are washable. Please make sure your hair is tied • Ensure that the waiting room enables patients to maintain
up and avoid wearing jewelry. a distance of 1.5-2 m between each other.
8 Please try not to wear bracelets, watches, necklaces, or • Provide patients with hand sanitizer at the door and with
earrings on the day you undergo testing. a mask if they have not brought one from home.
9 You must be wearing a mask when you arrive, and you cannot remove • There should be a clean, well-signposted circuit, in addi-
it during your stay in the hospital. tion to staff who can inform patients and facilitate access
10 You must enter the hospital unaccompanied unless you to the clinic in order to prevent them from walking around
need help. Only minors or people with special needs the highest-risk areas.
(elderly and dependent persons) can be accompanied. • If a patient has to partially undress, then he/she should
Persons accompanying patients to the hospital must have access, where possible, to an individual consulting
remain outside or in the car. room or stretcher where clothes can be left. Clothes will
11 You must follow the recommendations of the staff at be kept in a disposable bag. It is important to ensure
the center and maintain the recommended safe distance appropriate disinfection of surfaces and of other areas
(1.5-2 m). such as chairs and door handles between one patient and
12 While in the hospital do not touch anything (e.g., doors, handles) the next.
and maintain a safe distance from other people. Avoid • Gloves and mask should be worn when receiving patients,
crowding. during the visit, and during the patch tests. The use of
13 In the clinic, we will try to speak as little as necessary. safety glasses or a face shield and an impermeable gown
Where possible, every effort will be made to send notifi- will be evaluated in specific cases (possible risk of aerosol
cations and information by e-mail so that you do not have transport).
to take papers from the hospital to your home. If this is • Apply hand antiseptic (gel/water-alcohol solution) before
not possible, you will have to disinfect the papers when and after each patient.
you arrive home or leave them in a safe place where they • Collect the informed consent document in a plastic sheath
will not contaminate other objects. supplied by the hospital (standard).
14 Your belongings (e.g., clothing, bag) will be placed on • Apply tests using gloves that can be discarded after each
the stretcher (clean sheets for each patient) or hung up patient.
in the consulting room. For your safety, please take care • Patch tests can be marked using adhesive mate-
not to touch anything. You will have to strip to the waist. rial (preferably surgical steri-strip), individual acetate
The required test patches and your own products will be sheets, or 1 marker per patient. Disinfect the area to be
applied to your back. marked with water-alcohol solution.

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 654 J.M. Carrascosa et al.

• In the case of patients who bring their own products, these achieving global surgery goals. World J Surg. 2020;44:2451---7,
should be provided in individual bags and handled while http://dx.doi.org/10.1007/s00268-020-05627-7.
wearing gloves 2. Gisondi P, Piaserico S, Conti A, Naldi L. Dermatologists
• Establish appropriate ventilation of areas between one and SARS-CoV-2: the impact of the pandemic on daily
patient and the next. practice. J Eur Acad Dermatol Venereol. 2020;34:1196---201,
http://dx.doi.org/10.1111/jdv.16515.
• During the removal of patches and the first reading, fol-
3. Katerina D, Lence N, Viktor S, Andrej P, Irena D, Natasa
low the procedures and recommendations indicated for T. Impact of COVID-19 outbreak on dermatology services:
application of the patch test. dermatology in isolation. Dermatol Ther. 2020;10:e13552,
• During the week, give patients the option to store their http://dx.doi.org/10.1111/dth.13552.
own products in clean bags that can remain in the hospital
until the tests are complete.

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C. Exploring the impact of COVID-19 on progress towards

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For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.