Allergic contact dermatitis from topical corticosteroid preparations

image Allergic reactions to corticosteroids have been frequently reported from Europe since 1986. Screening with markers of steroid allergy such as tixocortol privalate and testing with steroids in ethanol have accounted for most of the reports. Since adding tixocortol to the standard tray in 1992, we also have noted an increase in topical steroid allergy. image The purpose of this article is to report our experience with steroid allergies, including vehicles, before 1992, when we made the diagnosis by testing with the patientʹs commercial steroid products, the active steroid (usually in petrolatum), and the standard and vehicle and preservative trays. image An 11-year retrospective review of our patch test results for topical corticosteroid contact dermatitis was performed. Patients with allergy to the active steroid, a coactive ingredient, and a vehicle were included with the exception of those patients allergic to the original Mycolog preparation (E.R. Squibb, Princeton, NJ). image From February 1981 to November 1991, 19 patients were found to have contact dermatitis to commercial topical steroid preparations. Eight patients had allergic reactions to the active steroid itself 0(amcinonide in 3 patients, hydrocortisone in 2, hydrocortisone-17-valerate in 1, and multiple topical steroids in 2). Three patients had allergic reactions to the active steroid, hydrocortisone in 3 cases, and a vehicle or coactive ingredient (neomycin). Seven patients had allergic reactions to the vehicle ingredients alone: either propylene glycol, lanolin alcohols, parabens, or benzyl alcohol. In 1 patient, the allergen in the hydrocortisone cream was undetermined. Eighteen patients had eczema, and 1 patient had morphea. Duration of the reactions ranged from 2 weeks to 12 years. The reactivity rate for corticosteroid allergy for the 11 years of this study was approximately 0.3%, in contrast to a 2.7% rate for the past 2 years, when tixocortol privalate was added to our standard tray. image We conclude that it is still appropriate to test suspected corticosteroid allergic patients with their own topical steroid, the standard screening tray, and the vehicle and preservative tray in addition to screening with markers such as tixocortol pivalate. Allergic patients should be tested further to identify topical steroids that they may tolerate.