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The benefit of patch testing with a corticosteroid at a low concentration
M Isaksson1, M Bruze, B Björkner
1Department of Occupational and Environmental Dermatology, Malmö University Hospital, Malmö, Sweden.
Summary
Patch testing with corticosteroid marker molecules can be improved by using lower concentrations and extended reading times. This case highlights the effectiveness of a 0.1% tixocortol pivalate concentration and a 0.202% corticosteroid mix for diagnosing allergies, especially with late readings.
Area of Science:
- Dermatology
- Allergology
- Contact Dermatitis
Background:
- Patch testing with corticosteroid marker molecules is crucial due to the impracticality of testing all available corticosteroids.
- Commonly used markers include budesonide, tixocortol pivalate, and hydrocortisone-17-butyrate.
- Corticosteroid mixes at varying concentrations are also employed in patch testing protocols.
Observation:
- A patient presented with a suspected allergy to tixocortol pivalate.
- Diagnosis was achieved using a lower-than-recommended concentration of tixocortol pivalate (0.1%) and a weak corticosteroid mix (0.202%).
Findings:
- Standard patch test readings on day 3 were negative for all corticosteroid preparations.
- Positive reactions to 0.1% tixocortol pivalate and the 0.202% corticosteroid mix were observed on day 7 (late reading).
- All tested corticosteroids in the standard series showed positive reactions by day 10.
Implications:
- Utilizing lower corticosteroid concentrations in patch testing may aid in diagnosing allergies.
- Extended reading times (beyond day 4) are significant for identifying delayed hypersensitivity reactions to corticosteroids.
- This approach can improve the diagnostic accuracy of corticosteroid patch testing.