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Patch Test Reactions to Corticosteroids: Retrospective Analysis From the North American Contact Dermatitis Group
Melanie D Pratt1, Asfandyar Mufti, Jennifer Lipson
1From the *Division of Dermatology and †Faculty of Medicine, University of Ottawa, Ontario, Canada; ‡Department of Dermatology, University of Minnesota, Minneapolis; §University of California, San Francisco; ∥Department of Dermatology, Cleveland Clinic Lerner College of Medicine, OH; ¶Department of Medicine, Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada; #Division of Dermatology, University of Toronto, Ontario, Canada; **Ohio State University, Columbus; ††Associates in Dermatology, Fort Myers, FL; ‡‡Department of Dermatology, University of Cincinnati, OH; §§Dartmouth-Hitchcock Medical Center, Lebanon, NH; ∥∥University of Southern California, Keck School of Medicine, Los Angeles; ¶¶University of Louisville, KY; ##Department of Dermatology, Pennsylvania State University, University Park, Hershey; ***Department of Dermatology, Oregon Health Science University, Portland; and †††Department of Dermatology, Columbia University, New York, NY.
Corticosteroid hypersensitivity is common, with tixocortol-21-pivalate showing the highest positivity. While most patients react to a single corticosteroid, co-reactivity between certain compounds like desoximetasone and budesonide was observed.
Area of Science:
- Dermatology
- Allergy and Immunology
- Pharmacology
Background:
- Delayed hypersensitivity reactions can be triggered by corticosteroids.
- Corticosteroids are classified into structural groups (A, B, C, D1, D2) and newer systems (1, 2, 3).
- Predicting cross-reactions between corticosteroids is challenging.
Purpose of the Study:
- To analyze patch test results for corticosteroid hypersensitivity.
- To identify patterns of positive reactions and co-reactions to various corticosteroids.
Main Methods:
- Retrospective analysis of 17,978 patients patch tested between 2007 and 2014.
- Tested corticosteroids included tixocortol-21-pivalate, budesonide, triamcinolone acetonide, desoximetasone, clobetasol-17-propionate, and hydrocortisone-17-butyrate (HC-17-B).
- Evaluation of reaction frequency, strength, and co-reactivity patterns.
Main Results:
- 4.12% of patients exhibited positive reactions to at least one corticosteroid.
- Tixocortol-21-pivalate (2.26%) was the most frequent positive reaction, followed by budesonide (0.87%) and HC-17-B (0.43%).
- Strong reactions were more common with tixocortol and budesonide; highest co-reactivity was noted between desoximetasone and budesonide.
Conclusions:
- Corticosteroid sensitivity is a significant clinical issue.
- Positivity frequencies align with structural classifications (Group A, B, D2).
- Further research is required to elucidate structural cross-reactivity patterns.