PATTERN-ANALYSIS OF PHOTOPATCH TEST REACTIONS

In a multicenter study, photopatch test results from more than 1500 patients were evaluated between 1985 and 1990 and from 614 patients between 1990 and 1992. Photopatch testing was conducted according to a standardized procedure. Nearly half of the photoreactions were unclassifiable according to the classic definitions of photoallergic or phototoxic reactions. To facilitate the interpretation of these remaining photopatch test reactions, we developed a computerized substance specific reaction pattern analysis. By sequential readings from immediately after irradiation up to 72 h later and by morphological qualification of the reactions, the time course and morphological changes of each individual reaction were monitored. The summation of each individual photoreaction resulted in an overall reaction pattern of a specific substance. Four main categories could be distinguished. The first category was characterized by a peak immediately after irradiation followed by a decrescendo reaction. The second category comprized reactions combining an immediate with a delayed reaction. The third category exhibited a plateau-like delayed reaction. The fourth category showed delayed reactions in a crescendo pattern. Whereas category 1 represents classic phototoxic and category 4 classic photoallergic reaction patterns, the underlying mechanisms of categories 2 and 3 remain to be investigated. Typical substances of category 1 were many of the tested systemic drugs, such as furosemide, most of which are well-known phototoxic agents. Disinfectants, nonsteroidal anti-inflammatory agents and phenothiazines showed the reaction patterns of categories 2 and 3, A delayed-type reaction (category 4) could be demonstrated for well-known photoallergens such as fenticlor, musk ambrette, and ultraviolet adsorbents in sunscreens. To prove the specifity of the cumulative reaction patterns, a second test series was analyzed, including 614 patients. Comparison of the reaction patterns from 1985-1990 with the reaction patterns from 1990-1992 showed in most cases a virtual indentity. Therefore, it is concluded that pattern analysis reveals a characteristic feature of a given substance, opening new aspects for evaluation of photosensitizing substances.