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Patch Test Reactions to Corticosteroids: Retrospective Analysis From the North American Contact Dermatitis Group 2007–2014

Pratt, Melanie D. MD; Mufti, Asfandyar BMSc; Lipson, Jennifer MD; Warshaw, Erin M. MD; Maibach, Howard I. MD; Taylor, James S. MD; Sasseville, Denis MD; DeKoven, Joel G. MD; Zirwas, Matthew J. MD; Fransway, Anthony F. MD; Mathias, C.G. Toby MD; Zug, Kathryn A. MD; DeLeo, Vincent A. MD; Fowler, Joseph F. Jr MD; Marks, James G. MD; Storrs, Frances J. MD; Belsito, Donald V. MD

doi: 10.1097/DER.0000000000000251

Introduction Corticosteroids may cause delayed hypersensitivity. On the basis of structure, the following 4 groups of corticosteroids are recognized: A, B, C, and D (subdivided into D1 and D2). More recently, a newer classification system subdivides corticosteroids into groups 1, 2, and 3. Cross-reactions are unpredictable. The objective of this study was to describe positive patch test and co-reaction patterns to corticosteroids.

Methods and Results A retrospective analysis of 17,978 patients patch tested by the North American Contact Dermatitis Group between 2007 and 2014 was performed. Corticosteroids tested during this period included the following: tixocortol-21-pivalate 1.0% petroleum (pet), budesonide 0.1% pet, triamcinolone acetonide 1.0% pet, desoximetasone 1.0% pet, clobetasol-17-propionate 1.0% pet, and hydrocortisone-17-butyrate (HC-17-B) 1.0% (pet and alcohol). Overall, 4.12% (n = 741) of patients had 1 or more positive reactions to corticosteroids. Tixocortol-21-pivalate positivity was the most common (2.26%), followed by budesonide (0.87%), HC-17-B (0.43%), clobetasol-17-proprionate (0.32%), and desoximetasone (0.16%). Reaction strength was strong (++ or +++) in almost twice as many tixocortol and budesonide reactions (>64%) as compared with the other 3 corticosteroids (<34.5%). Of the patients with positive corticosteroid reactions (n = 741), most (70.7%) had sensitivity to only 1 corticosteroid. Co-reactivity was highest between desoximetasone and budesonide.

Conclusions Sensitivity to corticosteroids is important. Consistent with other studies, the highest frequency of corticosteroid positivity was seen in group A (tixocortol-21-pivalate), followed by group B (budesonide) and D2 (HC-17-B). Co-reactivity varied; more studies are needed to fully understand structural cross-reactivity.

From 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.

Address reprint requests to Asfandyar Mufti, BMSc, 451 Smyth Rd, Ottawa, Ontario, Canada. E-mail:

The authors have no funding or conflicts of interest to declare.

The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs or the US government.

© 2017 American Contact Dermatitis Society
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