Widely used drugs in dermatology. Allergy to hydrocortisone has been reported for the first time in 1959.
There are 4 chemical/structural classes of corticosteroids.
- A: hydrocortisone, prednisolone, tixocortol pivalate
- B: acetonides (triamcinolone, desonide, budesonide)
- C: betamethasone, dexamethasone, desoxymethasone, fluocortolone
- D: esters: hydrocortisone-17-butyrate, betamethasone-vale rate, betamethasone-dipropionate, carbonates, carboxylates.
0.4% to 6.4% of positive patch-tests to different topical corticosteroids in populations with contact dermatitis.
189/7238 patients (2.6%) in a multicentre European study.
Long term application of topical corticosteroids (leg ulcers, atopic dermatitis, psoriasis, lichen planus).
The diagnosis of topical corticosteroid allergy is often difficult due to the anti-inflammatory action on cutaneous lesions and their delayed appearance.
- Increased eczema despite well-conducted topical treatment
- Eczematization of chronic dermatosis (seborrheic dermatitis, leg ulcers, psoriasis)
- Reactivation of eczema following oral, parenteral or intra- articular administration of a corticosteroid.
- Anaphylaxis, urticaria, angioedema following parenteral ad ministration of a corticosteroid.
Patch-tests must be read at 48 and 96 hours, but also at day 7 or 10 (delayed reactions due to the anti-inflammatory effects of the topical corticosteroids).
Interpretation of the tests is often difficult due to vasoconstriction or vasodilatation effects. In dubious cases, a repeated open application test with the corticosteroid preparation or a serial dilution of patch testing may be useful.
Among the corticosteroids, budesonide and tixocortol pivalate give the highest positive patch-tests (1.4%); followed by hydrocortisone-17-butyrate (1%). Clobetasol propionate and betamethasone valerate have the lowest frequency.
Delayed contact hypersensitivity.
Topical corticosteroids should be included in standard patch testing: budesonide, tixocortol pivalate, hydrocortisone-17-butyrate are the best candidates.
Cross-reactivity between corticosteroids may be found in patch testing but is not always clinically relevant.