Patch testing for corticosteroid allergy

During the 1990s, contact allergy to topical corticosteroids became a well-recognized complication of dermatologic therapy. Groups of related corticosteroids were subsequently identified on the basis of their chemical structures, and some investigators have found these helpful in identifying potential cross-reactions. The widespread use of hydrocortisone as an over-the-counter medication and its addition to a wide array of topical products make hydrocortisone the most common allergen. Awareness of the risk of corticosteroid allergy and the availability of newer topical immunomodulating agents such as tacrolimus and pimecrolimus may eventually reduce the incidence of contact allergy to corticosteroids. Rokea el-Azhary, MD, PhD, Professor of Dermatology at the Mayo Clinic in Rochester, MN; Erin Warshaw, MD, Associate Professor of Dermatology at the University of Minnesota, Veterans Affairs Medical Center; and Kalman L. Watsky, MD, Associate Clinical Professor, Department of Dermatology, Yale University School of Medicine, and Section Chief of Dermatology, Hospital of Saint Raphael, were invited to give their opinions on strategies for detecting allergens and recommending allergen substitution for patients with suspected topical corticosteroid allergy.