J. Soc. Cosmet. Chem., 25, 153-158 (March 1974) The Commission of Sin through the Medium of the Skin Patch Test EARLE W. BRAUER, M.D.* Presented May 4, 1973, Seminar, Cincinnati, Ohio Synopsis-The SKIN PATCH TEST is a valuable instrument. In the hands of well- meaning, but misguided, individuals the power of this instrument is creating significant PROBLEMS for MEDICINE in general and for the COSMETIC INDUSTRY in particular. INTRODUCTION In 1900, Jadassohn introduced the concept of the skin patch test (1). In the interim an extensive evolutionary process has produced many variations in technic and scope. A thread of relationship exists among these diverse test procedures occasionally it is obliterated completely. All are performed upon normal or altered skin with the intent of measuring the degree of reactivity of this organ to a test substance offered under a contrived environmental state. The intent of this report is neither to catalogue these many tests nor to dwell on the inestimable contribution each has made to research, medicine, and industry. Instead, the focus of attention will be placed on modes of op- eration in which the patch test may occasionally be the direct or supportive mechanism for disseminating unnecessary confusion in the laboratory, the clinician's office, as well as the market place confusion which may occur innocently enough, and can be avoided. The cosmetic industry is significantly affected by skin patch-test conduct, and therefore a discussion of this subject is opportune. * New York University School of Medicine, New York, N.Y., and Revlon Research Center, Inc., 945 Zerega Ave., Bronx, N.Y. 10473. 153

154 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS MODES OF OPERATION Example I Well-intentioned authors writing in reputable medical journals publish ar- ticles with all-inclusive titles linking allergie eontaet type dermatitis to a consumer product, not necessarily from a single inanufaeturer, such as a pow- der puff, nail base-coat, eye glass, and perfuxne. A vivid description of the eruption is linked to product usage and then conclusively proven by a lesser or greater eolleetion of sophisticated positive pateh test data. The effect of tiffs approach in the current elimate of consumerism and eon- trols is enormous. Immediately, the reader dermatologist acquires a new mini- syndrome and the nation's lay science writers uneover an exeiting threat to society to reveal in their syndicated columns. Even the Wall Street Journal runs an item on it. The author of one such report discovered 9 eases in a single year from an "average" practice in close proximity to a metropolitan area. In his hurried study 19 separate products in the class were involved. Let us aeeept the skin test data as unimpeachable and assume this author's experienee refieets what is happening in a practice population of approximately 100,000. Extrapolating these figures to the general population by any of several teeh- hies, we should expect 18,000 to 27,000 professionally recognized com- plaints annually to this class of consumer produet. In an informal poll of 12 dermatologists with American Board certification associated with a major metropolitan teaching eenter-men and women whose practices reflect experience from a population greater than 1,000,000-the yield of suspected eases of dermatitis attributable to the consumer produet in question did not reach 9 for the entire group in the more than 2 years since the original article was published. Why this wide discrepancy, particularly with consumer sales of this prod- uct category increasing anmmlly? Example II We are a society of collectors h'om antique automobiles to zithers. We search for the rare and dream of the unobtainable. Each time the stamp col- lector approaches the Postal Service window to purchase the latest com- memoratives he relives the fantasy of being handed a sheet of stamps with the airplane upside down. Some of my dermatologic colleagues achieve this exhilaration through publication of the medical curiosity (in this instance the first documented report of an allergic contact dermatitis to substance X) confirmed by positive skin patch test. There is no quarrel with the need for cataloguing such information. Per- haps the North American or International Contact Dermatitis Research Groups should be the repository. Why, however, is a trivial tidbit of knowl-