Cutaneous-mucosal allergic contact reaction due to topical corticosteroids

We report the case of a 41-year-old nonatopic women with a previous history of eczematous reaction due to hydrocortisone who suffered worsening of her perennial rhinitis in association with perinasal dermatitis from the use of budesonide in nasal spray form, and stomatitis and pharyngitis due to budesonide in a bronchial inhaler. Patch tests with a series of 25 corticosteroids, some of them at different concentrations and in different vehicles, were positive to tixocortol pivalate, hydrocortisone, budesonide, prednisolone, hydrocortisone butyrate propionate, triamcinolone acetonide, and fluocinolone acetonide. For some of them, a 1% solution in ethanol gave a positive reaction when a 20% mixture in petrolatum did not. Like other authors, we suggest that some multiple positives may represent sensitization to several steroids independently, true cross-reactions, or both, and that ethanol is a better vehicle than petrolatum.