Advertisement

Corticosteroid classes: A quick reference guide including patch test substances and cross-reactivity

  • Sharon E. Jacob
    Correspondence
    Reprint requests: Sharon E. Jacob, MD, Director, Contact Dermatitis Clinic, University of Miami, Department of Dermatology and Cutaneous Surgery, 1600 NW 10th Ave, R-250, Rosensteil Medical School Building, Miami, FL 33136.
    Affiliations
    From the Miller School of Medicine, University of Miami, Department of Dermatology and Cutaneous Surgery
    Search for articles by this author
  • Tace Steele
    Affiliations
    From the Miller School of Medicine, University of Miami, Department of Dermatology and Cutaneous Surgery
    Search for articles by this author
      In the 2004 Burden of Skin Disease study conducted by the American Academy of Dermatology Association and the Society for Investigative Dermatology, approximately 90.6 million Americans were reported to be affected by psoriasis, atopic dermatitis, and allergic contact dermatitis.

      Most prevalent skin diseases impact millions of Americans: Burden of Skin Disease study finds several diseases to be quite common. Dermatology World 2005;May:1 & 24.

      Importantly, the leading therapeutic modality for these dermatitides is unquestionably topical corticosteroids. Although allergic contact dermatitis to topically applied corticosteroids was first reported in 1959, corticosteroid allergy has only been a widely recognized entity for the past 17 years.
      • Scheuer E.
      • Warshaw E.
      Allergy to corticosteroids: update and review of epidemiology, clinical characteristics, and structural cross-reactivity.
      In their patch test results for 2001 and 2002, the North American Contact Dermatitis Group reported a 3% incidence rate in positive reactions to tixocortol-21-pivalate (up from 2.7% the year before), a 1.1% incidence rate for budesonide, and a 0.5% incidence rate for hydrocortisone-17-butyrate.
      • Pratt M.D.
      • Belsito D.V.
      • DeLeo V.A.
      • Fowler Jr., J.F.
      • Fransway A.F.
      • Maibach H.I.
      • et al.
      North American Contact Dermatitis Group patch-test results, 2001-2002 study period.
      In fact, this family of allergens has become so prevalent that the North American Contact Dermatitis Group added triamcinolone acetonide and clobetasol-17-propionate to the 2003 standard series.
      • Pratt M.D.
      • Belsito D.V.
      • DeLeo V.A.
      • Fowler Jr., J.F.
      • Fransway A.F.
      • Maibach H.I.
      • et al.
      North American Contact Dermatitis Group patch-test results, 2001-2002 study period.
      With broad and vast utilization, it stands to reason that corticosteroids became recognized as the American Contact Dermatitis Society's 2005 allergen of the year.
      • Marléne I.
      • Magnus B.
      Contact allergen of the year: corticosteroids.
      The anti-inflammatory nature of corticosteroids makes the diagnosis of allergy more difficult, but should be considered in patients suffering from intractable dermatitis.
      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Most prevalent skin diseases impact millions of Americans: Burden of Skin Disease study finds several diseases to be quite common. Dermatology World 2005;May:1 & 24.

        • Scheuer E.
        • Warshaw E.
        Allergy to corticosteroids: update and review of epidemiology, clinical characteristics, and structural cross-reactivity.
        Am J Contact Dermatitis. 2003; 14: 179-187
        • Pratt M.D.
        • Belsito D.V.
        • DeLeo V.A.
        • Fowler Jr., J.F.
        • Fransway A.F.
        • Maibach H.I.
        • et al.
        North American Contact Dermatitis Group patch-test results, 2001-2002 study period.
        Dermatitis. 2004; 15: 176-183
        • Marléne I.
        • Magnus B.
        Contact allergen of the year: corticosteroids.
        Dermatitis. 2005; 16: 3-5
        • Coopman S.
        • Degreef H.
        • Dooms-Goossens A.
        Identification of cross-reaction patterns in allergic contact dermatitis from topical corticosteroids.
        Br J Dermatol. 1989; 121: 27-34
        • Isaksson M.
        Corticosteroids.
        Dermatol Ther. 2004; 17: 314-320
        • Isaksson M.
        • Bruze M.
        Corticosteroids.
        Dermatitis. 2005; 16: 3-5
        • Lepoittevin J.P.
        • Drieghe J.
        • Dooms-Goossens A.
        Studies in patients with corticosteroid contact allergy: understanding cross-reactivity among different steroids.
        Arch Dermatol. 1995; 131: 31-37
        • Matura M.
        • Goossens A.
        • Matura M.
        Contact allergy to corticosteroids.
        Allergy. 2000; 55: 698-704
        • Oh-i T.
        Contact dermatitis due to topical steroids with conceivable cross reactions between topical steroid preparations.
        J Dermatol. 1996; 23: 200-208
        • Rietschel R.L.
        Patch testing for corticosteroid allergy in the United States.
        Arch Dermatol. 1995; 131: 91-92
      2. Rietschel R.L. Fowler J.F. Fisher A.A. Fisher's contact dermatitis. Williams & Wilkins, Baltimore1995
        • Scheuer E.
        • Warshaw E.
        Allergy to corticosteroids: update and review of epidemiology, clinical characteristics, and structural cross-reactivity.
        Am J Contact Dermat. 2003; 14: 179-187
        • Wilkinson S.M.
        Corticosteroid cross-reactions: an alternative view.
        Contact Dermatitis. 2000; 42: 59-63