Contact sensitization to corticosteroids: increased risk in long term dermatoses

Abstract

Patients affected by chronic dermatoses are at high risk for the development of sensitization to corticosteroids. This study was carried out to evaluate contact hypersensitivity to corticosteroids in a selected group of patients affected by longlasting cutaneous dermatoses. Sixty subjects underwent the GIRDCA series. The Italian GIRDCA series we applied had the following substances in addition to the European standard series: imidazolidinyl urea 2% pet, thiomersal 0.1% pet, disperse yellow 31% pet, disperse red 1% pet, 4'4-diaminodiphenylmethane 0.5% pet, ammoniated mercury 1% pet. The patients were tested with our corticosteroids series and some of them also with their own steroid products. Allergic reactions to corticosteroids were observed in 8/60 (13.3%) patients; budesonide was the main sensitizer (7 positives) followed by hydrocortisone-17-butyrate and betamethasone-17-valerate (2 and 1 positives, respectively). One patient also reacted to methylprednisolone aceponate contained in her own cream. 4/8 positives were certainly related to previous drug-exposure. This study showed a very high percentage of sensitization to corticosteroids. In our opinion, this value may be due both to our selection-standards and to the wide employment of a well known sensitizer like budesonide in our country. Although a corticosteroids series like ours seems to be adequate for the detection of sensitized patients, patch tests with individual compounds and/or steroids corresponding to local prescription habits are recommended, especially in unresponsive chronic dermatoses.