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Latest revision as of 18:11, 29 December 2020

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: Pathergy

Overview

The pathergy test, is a non-specific skin or mucus membrane 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.

Historical Perspective

Skin pathergy test was first reported by Blobner in 1937.^[1]

Procedure

Skin Pathergy test
There is no standardized method for performing the pathergy test. However, the method below is one of the suggested ways.^[2]^[3]
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 The needle should not be observed beneath the epidermis and then it should be withdrawn with a twisting movement.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
- 1+ papule only
- 2+ pustule

Another scale for the interpretation of the test, known as Dilsen pathergy test, is indicated in the table below:^[4]


Test result	Clinical characteristic of the needle mark at 48 h
Negative	Only erythema <2 mm
Undetermined	Only erythema >3 mm or papule 1-2 mm + erythema <2 mm
Positive	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:^[1]^[2]

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
Use a blunt needle to prick

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:^[4]

Positive Result: Presence of pustule and/or ulcer
Negative Result: Absence of aforementioned 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:^[2]^[5]

Behçet’s disease (the skin pathergy test is a specific diagnostic tool for this disorder)
Pyoderma gangrenosum
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
spondyloarthropathies (rarely)

References

↑ ^1.0 ^1.1 Dilsen, N; Konice, M; Aral, O; Ocal, L; Inanc, M; Gul, A (1993). "Comparative study of the skin pathergy test with blunt and sharp needles in Behcet's disease: confirmed specificity but decreased sensitivity with sharp needles". Annals of the Rheumatic Diseases. 52 (11): 823–825. doi:10.1136/ard.52.11.823. ISSN 0003-4967.
↑ ^2.0 ^2.1 ^2.2 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.
↑ ^4.0 ^4.1 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.
↑ Sequeira, FionaF; Daryani, Deepak (2011). "The oral and skin pathergy test". Indian Journal of Dermatology, Venereology, and Leprology. 77 (4): 526. doi:10.4103/0378-6323.82399. ISSN 0378-6323.

Template:WikiDoc Sources

[DilsenKonice1993-1] 1.0 ^1.1 Dilsen, N; Konice, M; Aral, O; Ocal, L; Inanc, M; Gul, A (1993). "Comparative study of the skin pathergy test with blunt and sharp needles in Behcet's disease: confirmed specificity but decreased sensitivity with sharp needles". Annals of the Rheumatic Diseases. 52 (11): 823–825. doi:10.1136/ard.52.11.823. ISSN 0003-4967.

[BakerSmith2011-2] 2.0 ^2.1 ^2.2 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.

[OzdenBek2010-3] 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.

[SharquieAl-Araji2002-4] 4.0 ^4.1 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.

[SequeiraDaryani2011-5] Sequeira, FionaF; Daryani, Deepak (2011). "The oral and skin pathergy test". Indian Journal of Dermatology, Venereology, and Leprology. 77 (4): 526. doi:10.4103/0378-6323.82399. ISSN 0378-6323.

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
+__NOTOC__
 {{SI}}
-{{CMG}}; {{AE}} {{Sahar}}
+{{CMG}}; {{AE}} {{Sahar}}<br>
+{{SK}} [[Pathergy]]
 ==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 disease|Behçet’s disease]].
+The '''pathergy test''', is a non-specific [[skin]] or [[mucus membrane]] reaction to trauma that is observed in patients with [[Behçet disease]]. This reaction is [[Classification|classified]] as a [[hypersensitivity]] reaction. The positive pathergy test is one of the minor [[diagnostic]] criteria of [[Behçet disease|Behçet’s disease]].
+==Historical Perspective==
+[[Skin]] pathergy [[test]] was first reported by Blobner in 1937.<ref name="DilsenKonice1993">{{cite journal|last1=Dilsen|first1=N|last2=Konice|first2=M|last3=Aral|first3=O|last4=Ocal|first4=L|last5=Inanc|first5=M|last6=Gul|first6=A|title=Comparative study of the skin pathergy test with blunt and sharp needles in Behcet's disease: confirmed specificity but decreased sensitivity with sharp needles.|journal=Annals of the Rheumatic Diseases|volume=52|issue=11|year=1993|pages=823–825|issn=0003-4967|doi=10.1136/ard.52.11.823}}</ref>
 ==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:'''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:
+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)
-* '''Positive Result:''' the presence of papule or pustule.
+* '''Positive Result:''' the presence of [[papule]] or [[pustule]]
 ** 1+ [[papule]] only
 ** 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>
 {| class="wikitable"
 |+
 |-
-| align="center" style="background:#f0f0f0;" |'''Test result'''
+| style="background: #4479BA; width: 100px;" align="center"| {{fontcolor|#FFF|'''Test result'''}}
-| align="center" style="background:#f0f0f0;" |'''Clinical characteristic of the test at 48 h'''
+| style="background: #4479BA; width: 350px;" align="center"| {{fontcolor|#FFF|'''Clinical characteristic of the needle mark at 48 h'''}}
 |-
-|Negative result
+|
-|Only erythema <2 mm
+* Negative
+|
+* Only erythema <2 mm
 |-
-|Undetermined
+|
-|Only erythema >3 mm or papule 1-2 mm + erythema <2 mm
+* Undetermined
+|
+* Only erythema >3 mm or papule 1-2 mm + erythema <2 mm
 |-
-| rowspan="4" |Positive result
+| rowspan="4" |
-|1+ Papule 2-3 mm + erythema >3 mm
+* Positive
+|
+* 1+ Papule 2-3 mm + erythema >3 mm
 |-
-|2+ Papule >3 mm + erythema >3 mm
+|
+* 2+ Papule >3 mm + erythema >3 mm
 |-
-|3+ Pustule 1-2 mm + erythema >3 mm
+|
+* 3+ Pustule 1-2 mm + erythema >3 mm
 |-
-|4+ Pustule >2 mm + erythema >3 mm
+|
+* 4+ Pustule >2 mm + erythema >3 mm
 |}
-To increase the [[sensitivity]] of the test:
+To increase the [[sensitivity]] of the test:<ref name="DilsenKonice1993">{{cite journal|last1=Dilsen|first1=N|last2=Konice|first2=M|last3=Aral|first3=O|last4=Ocal|first4=L|last5=Inanc|first5=M|last6=Gul|first6=A|title=Comparative study of the skin pathergy test with blunt and sharp needles in Behcet's disease: confirmed specificity but decreased sensitivity with sharp needles.|journal=Annals of the Rheumatic Diseases|volume=52|issue=11|year=1993|pages=823–825|issn=0003-4967|doi=10.1136/ard.52.11.823}}</ref><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>
 * make at least two [[needle]] pricks on the glabrous [[skin]] of the forearm
-* Use a large [[hypodermic]] needle (21 g or less)
+* Use a large [[hypodermic]] needle (21 gauge or less)
 * Use four [[needle]] pricks in total
-'''Oral pathergy test'''
+* Use a blunt [[needle]] to prick
+'''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 [[Pustules|pustule]] and/or [[ulcer]]
+* '''Negative Result:''' Absence of aforementioned [[lesions]]
+This method is more accessible than the traditional [[skin]] test, as there is no need to measure the size of the [[lesion]] and [[Pustules|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 [[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><ref name="SequeiraDaryani2011">{{cite journal|last1=Sequeira|first1=FionaF|last2=Daryani|first2=Deepak|title=The oral and skin pathergy test|journal=Indian Journal of Dermatology, Venereology, and Leprology|volume=77|issue=4|year=2011|pages=526|issn=0378-6323|doi=10.4103/0378-6323.82399}}</ref>
-* [[Behçet disease|Behçet’s disease]]
+* [[Behçet disease|Behçet’s disease]] (the skin pathergy test is a specific [[diagnostic]] tool for this [[disorder]])
-* Pyoderma gangernosum
+* [[Pyoderma gangrenosum]]
 * [[Sweet’s syndrome]]
-* Atypical eosinophilic pustular folliculitis
+* Atypical eosinophilic pustular [[folliculitis]]
-* Neonates with [[Down syndrome]]
+*[[Neonates]] with [[Down syndrome]]
 * [[Myeloproliferative disease|Myeloproliferative disorders]]
 * [[Non-Hodgkin lymphoma|Non-Hodgkin’s lymphoma]]
 * [[Chronic myeloid leukemia]] treated with [[Interferon-alpha|interferon α]]
 * [[Inflammatory bowel disease]]
+*[[spondyloarthropathies]] (rarely)
 ==References==
 {{Reflist|2}}