Excited Skin Syndrome (Angry Back), What Do We Know About It? A Review of the Literature

In 1975, Mitchell brought up a theory that false positive reactions can be due to skin hyperirritability, called it “angry back syndrome” (ABS). The phenomenon is observed in patch testing of patients with several positive patch tests, mostly along with one or more strong reactions. Later, Maibach rephrased ABS to “excited skin syndrome” (ESS) because of generalized involvement of the skin, not only the back.