If "phototesting . . . with an irradiation monochromator" takes precedence over patch and photopatch testing in diagnosis and thereby prevention of environmental photodermatitis, something has gone wrong in the practice of clinical dermatology. Patch and photopatch testing, the continuation of the clinical processes of history taking and physical examination should not be relegated to "ancillary investigations," and a confident diagnosis of chronic actinic dermatitis (CAD) should not be made as a result of abnormal monochromatic light test and negative patch and photopatch test findings. Since the clinical evidence and the initial clinical assessment have indicated the need for such tests, the absence of positive test results indicates the need for further investigations, which might lead to previously unknown causative agents through further patch testing.
Burry JN. Chronic Actinic Dermatitis Is Not a Viable Concept—Reply. Arch Dermatol. 1999;135(4):470. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-4-dlt0499