Patch testing to detect corticosteroid allergy: is it adequate?
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Updated: Oct 11, 2026

Precision Implementation of Minimal Erythema Dose (MED) Testing to Assess Individual Variation in Human Inflammatory Response
Published on: October 3, 2019
D C Seukeran1, S M Wilkinson, M H Beck
1Department of Dermatology, General Infirmary at Leeds, UK.
Abstract:
Whilst patch testing with corticosteroids in ethanol is more sensitive than either petrolatum or the cream formulation, the frequency of false-negative reactions is not known. We have compared patch testing with corticosteroid at 1% in ethanol with intradermal (i.d.) tests using 1 mg corticosteroid suspended in normal saline. Patch tests with tixocortol pivalate and budesonide detected all patients allergic to hydrocortisone and budesonide, respectively. For other corticosteroids, the use of ethanol as a vehicle resulted in both false-positive and false-negative reactions. In particular, patch tests with hydrocortisone-17-butyrate missed 30% of all positive reactions detected by i.d. testing. There may be a case for advising the avoidance of this steroid in all patients who are positive on patch testing to tixocortol pivalate and budesonide.
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