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Pathergy test
  1. Mark R Baker1,2,
  2. Emma V Smith3,
  3. Osheik A Seidi1,4
  1. 1Registrar and Clinical Lecturer, Department of Neurology, Sunderland Royal Hospital, Sunderland, UK
  2. 2Registrar and Clinical Lecturer, Institute of Neuroscience, The Medical School, Newcastle upon Tyne, UK
  3. 3Consultant, Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, UK
  4. 4Consultant, Faculty of Medicine and Soba University Hospital, University of Khartoum, Khartoum, Sudan
  1. Correspondence to Dr M Baker, Institute of Neuroscience, The Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; m.r.baker{at}ncl.ac.uk

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A positive pathergy test is one of the four minor diagnostic criteria for Behçet's disease. However, there is no consensus as to the optimal method of testing pathergy in clinical practice. Here we describe an approach to performing the pathergy test based on the best available evidence and also explain how to interpret the result. Finally, we discuss briefly in which patients a neurologist might consider pathergy testing.

Background

Pathergy is a non-specific hypersensitivity reaction to skin trauma that can occur in patients with Behçet's disease. The histology of pathergy is characterised by variable epidermal thickening, epidermal cell vacuolisation, subcorneal pustule formation, upregulation of cell adhesion molecules (including intercellular adhesion molecule 1, endoglin, E-selectin and P-selectin1) and mixed perivascular inflammatory cell infiltrates (neutrophils, CD4 positive T cells and macrophages), which appear at 4 h, are densest at 24 h and begin to diminish after 48 h.1 2

The skin pathergy test is one of the minor diagnostic criteria for Behçet's disease …

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