A few months ago, I got hit with what my dermatologist called a “pretty severe” allergic reaction: The lower half of my face was hot to the touch and as red as a stop sign. And if that wasn’t enough, annoying little pustules were scattered across my jawline. To put it bluntly, I was miserable.
After some prescription-grade hydrocortisone cream, oral antibiotics, and a little time (10 days, to be exact), my face eventually went back to normal. But still, I couldn’t help but wonder what caused that sudden and unprecedented rash. I hadn’t added any new products to my routine, and I’m not prone to reactions like that.
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I’d thought about getting a skin patch test before and knew I probably needed one to get some answers. So, I reached out to Schweiger Dermatology Group to schedule one. Here’s a day-by-day rundown of the full experience—and what I learned about my sensitive skin.
What does a skin patch test do?
A skin patch test can help ID which (if any) topical ingredients you’re allergic to, says Susanna Silverman, MD, the board-certified allergist who performed my patch test (for free) at Schweiger Dermatology Group in New York City.
Here’s how it works: During the first of three appointments, a dermatologist or allergist covers your back with rows of tiny stickers that contain different allergens—including metals (like nickel), natural oils (like tea tree and ylang-ylang), and common skin care ingredients (fragrances, for example). A patch test only tests for contact allergens, or things that physically touch your skin—not airborne or food allergens, like pet dander or tree nuts.
You keep these stickers on your back for two days—during which you can’t sweat excessively (so no exercising) or shower—and then return to your provider to have them removed. Your doctor will examine your skin during this second appointment but, because some negative reactions can take a few days to show up, you’ll also come back two days later for a final assessment. At the end of the five-day experience, you’ll walk away with a list of what, if any, substances you’re allergic to.
According to Dr. Silverman, this analysis is a great way to “identify triggers for inflamed rashes caused by eczema.” The most common form of this condition is called atopic dermatitis, which usually looks like dry, inflamed patches of skin that are very itchy. (Experts don’t fully understand what causes atopic dermatitis, but genetics and environmental factors like climate and exposure to certain allergens can play a role.) There are other types of eczema too: Contact dermatitis (what I was dealing with) happens when your skin becomes irritated after reacting to a specific trigger—either an allergen (in the case of allergic contact dermatitis) or irritant (irritant contact dermatitis).
Health insurance will often cover some, if not all, of a skin patch test, “but out-of-pocket costs, if you don’t have insurance, can range from a few hundred dollars to $1,000,” Dr. Silverman says.
The day-by-day breakdown of my skin patch test experience
Naturally, my top priority was getting an answer to what the hell happened to my face. But also, I was hoping a patch test could tell me if any of the products in my rotation were causing parts of my face to turn red. (Even before the horrible rash, I’d notice my skin getting a bit tender or itchy when I used certain “actives.”) So, without further ado, let me walk you through exactly how my patch test went.
During my first appointment, a physician assistant applied 80 patches of different allergens all over my back and covered them with hypoallergenic tape.
Dr. Silverman emphasized that it was really important for me not to scratch, shower, or sweat so the patches would stay put until my follow-up appointment in two days. I also read online that it’s common to feel unbearably itchy when you’re taped up for this test, so I arranged to work from home for the week, just in case. My back definitely felt stiff and tight (making it difficult to bend or move freely—which was annoying). But the irritation ended up being pretty manageable overall.
I braced myself for a full day of discomfort (like I said, I had heard horror stories)—but, to my surprise, everything was fine. Only one part of my upper back (where I ended up having an allergic reaction) was slightly itchy, as if I had a mosquito bite. Other than that, I sailed through the day feeling like my usual self—except for the whole no-showering situation.
At night, the tape was making it really hard to fall asleep, since my back felt so stiff. But after a few hours of tossing and turning, I eventually drifted off. (Again, the discomfort was mostly from the tape, not the actual allergens.)
This was the day I’d been eagerly anticipating! Finally, Dr. Silverman removed the tape and patches, and then outlined and numbered the patches with a permanent marker. That way, we’d know which allergen was placed where.
I was definitely allergic to one of them: sesquiterpene lactone mix—a group of plant extracts found in many fragrances. “Positive results that indicate an allergy will usually be raised and itchy,” Dr. Silverman says, adding that the inflamed skin will also appear red, brown, purple, or grey, depending on the person’s skin tone. And that’s exactly how mine looked: As you can see from the picture below, there’s a bright red, bumpy square where the sesquiterpene patch was placed.
Still, I wasn’t as reassured as I had hoped: I didn’t think I owned any products formulated with this ingredient. So I was back at square one, wondering what really caused my giant face rash.
Honestly, not much happened: My back felt perfectly fine—though I still wasn’t allowed to shower or sweat, and I was told to wear dark, loose clothing (to prevent the permanent marker from rubbing off). Things were so normal, in fact, that I ended up going into the office to work with no problems whatsoever.
At my final reading, I learned that my skin was also (mildly) reacting to three additional allergens: 2-tert-Butyl-4-methoxyphenol (an antioxidant found in some foods and cosmetics), carba mix (a group of chemicals found in certain fungicides, pesticides, and rubber products), and topical tocopherol (vitamin E). All of these reactions were delayed, meaning the signs of irritation showed up three to five days after my skin was exposed to them.
As weird as this may sound, I felt a wave of relief after the final appointment. Deep down, I was never truly convinced that the sesquiterpene lactone mix caused my facial reaction. But some of the other ingredients I was allergic to (like vitamin E) were in my moisturizers and serums, so this newfound knowledge was a huge wake-up call.
Was it worth it?
Since the patch test was complimentary, I didn’t have to shell out any money for it (other than the $15 I spent on subway rides to and from the appointment). But knowing what I know now, I would have paid out-of-pocket. For starters, the peace of mind I got from simply knowing my triggers made the whole experience worthwhile (especially as someone who’s dealt with super-sensitive skin and mysterious rashes).
It also wasn’t a major time commitment: All three appointments combined took about an hour, max. Plus the discomfort was minimal, and serious side effects are rare, according to Dr. Silverman. She did tell me beforehand that “patch testing might leave small hyperpigmentation marks at the sites of positive tests, which can remain or take weeks to resolve,” but that risk didn’t stop me.
Since receiving my results, I edited my routine based on a “safe” list of skin care and makeup products (which my dermatologist’s office emailed me)—and of course, tossed out all of my products that contained vitamin E (which…was a lot of them). Perhaps it’s too soon to tell, but I haven’t had another flare-up yet—and for once, I feel like I’ve finally gained some control over managing my sensitive, reactive skin.
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