Contact Hypersensitivity to Glucocorticosteroids

Abstract

Contact hypersensitivity to corticosteroids manifesting as allergic contact dermatitis has previously been considered rare. This study was undertaken to study prevalence, clinical features, and mechanisms of this condition. A specific aim was to develop methods for diagnostic purposes. 8,362 patients undergoing standard patch test series because of suspected contact allergy were tested with corticosteroid(s) during 1985 to 1990. A steady increase in prevalence of contact allergy to hydrocortisone-17-butyrate from 0.3% to 1.4% was observed during these years. With tixocortol pivalate, a prevalence of 3.9% was found. The patients were further tested with a patch test series featuring various corticosteroids. Possible cross-reactions between corticosteroids were observed in 35 out of 80 patients with corticosteroid allergy. When patients with contact allergy to hydrocortisone were challenged with oral hydrocortisone, flare-up reactions in skin areas where hydrocortisone earlier had caused ezema were noted. A similar reaction was observed when the patient's intrinsic hydrocortisone secretion from adrenal cortex was stimulated with adrenocorticotropin (ACTH) analog. When T lymphocytes from patients with corticosteroid contact hypersensitivity were incubated with corticosteroid in vitro, proliferation responses were detected when epidermal Langerhans' cells were present but not when peripheral blood monocytes were present as antigen-presenting cells. When biopsy samples of allergic patch test reactions to corticosteroids were studied with immunohistochemistry, differences to reactions caused by noncorticosteroid contact allergens were found; these could possibly be explained by pharmacological action of corticosteroids. One conclusion of this study is that corticosteroid contact hypersensitivity is not rare. To avoid false-negative patch test reactions, ethanol is recommended as a vehicle for corticosteroids. In routine patch testing, tixocortol pivalate and hydrocortisone-17-butyrate would make useful screening agents.