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Abstract
ABSTRACT Allergic contact dermatitis from topical drugs is frequent and is seen in 10% to 17% of patients patch tested for suspected contact dermatitis. More than 360 drugs have been implicated as contact allergens, of which-generally-antibiotics, corticosteroids, local anesthetics, and nonsteroidal anti-inflammatory drugs are the most frequent culprits. This article provides an overview of allergic contact dermatitis to topical drugs, discussing their prevalence of sensitization, predisposing factors, clinical manifestations (both typical and atypical), the drugs described as allergens, cross-reactivity and coreactivity, and diagnostic procedures.
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Wilkinson SM, Beck MH. Hypersensitivity to topical corticosteroids in otitis externa. The Journal of Laryngology & Otology 2007; 107:597-9. [PMID: 15125274 DOI: 10.1017/s0022215100123801] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Over a12-monthperiod, nine patients were seen in a contact dermatitis clinic with an inflammatory dermatosis localized predominantly to the external auditory canal. Of these patients, four were found to have an allergic contact dermatitis which was exacerbating their dermatitis. All were allergic to one or more corticosteroids and topical antibiotics used in the treatment of their dermatitis. We would suggest that hypersensitivity to topical corticosteroids and other medicaments be considered in patients with otitis externa which fails to respond to treatment.
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Ferraz Amaro I, Díaz González F, González T. [Allergy to corticosteroids, a paradox?]. Med Clin (Barc) 2003; 120:141-5. [PMID: 12605840 DOI: 10.1016/s0025-7753(03)73628-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Iván Ferraz Amaro
- Servicio de Reumatología. Hospital Universitario de Canarias. La Laguna. Santa Cruz de Tenerife. España
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Affiliation(s)
- N Rocha
- Dermatology Department, Hospital Geral St. António, Porto, Portugal.
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Abstract
Patch-test technique for budesonide needs improvement. 20 subjects with positive or questionable patch-test responses to budesonide were retested for 3 to 96 h (4 days [D]) with polyester patches coated with budesonide in serial doses (150 to 0.074 microg/cm2). Multiple readings were taken visually and with a laser Doppler perfusion imaging technique up to 264 h (day [D]11). Additionally, all subjects were tested with 0.1% budesonide in petrolatum in Finn Chambers for 48 h (2D) with readings taken at 72 (D3), 96 (D4) and 168 h (D7). Different dose levels and application times affected unpredictably highest assessments of reactions. No clear suppression of reactivity was observed at high doses. Time points of highest assessments of reactions varied between subjects but were generally the same for each subject with both reading methods regardless of dose levels or application times. Positive and negative subjects during the study were easily distinguished with all serial doses, regardless of assessment technique. At 2.0 microg/cm2, the lowest dose level tested on all subjects, longer applications than 24 h (1D) were required to detect all positive subjects. 48-h (2-D) applications required 2 readings, optimally at 96 (D4) and 216 h (D9). The only test technique with Finn Chambers used here did not make such distinction possible.
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Affiliation(s)
- B Bjarnason
- Department of Dermatology, Karolinska Hospital, Stockholm, Sweden
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Marcos C, Allegue F, Luna I, González R. An unusual case of allergic contact dermatitis from corticosteroids. Contact Dermatitis 1999; 41:237-8. [PMID: 10515120 DOI: 10.1111/j.1600-0536.1999.tb06152.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C Marcos
- S. Alergología, Complejo Hospitalario Xeral-Cies, Vigo (Pontevedra), Spain
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Lutz ME, el-Azhary RA. Allergic contact dermatitis due to topical application of corticosteroids: review and clinical implications. Mayo Clin Proc 1997; 72:1141-4. [PMID: 9413294 DOI: 10.4065/72.12.1141] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Allergy due to topically applied corticosteroids is being recognized more frequently. Testing for hypersensitivity to these agents is performed with delayed hypersensitivity patch testing. Cross-reactivity among topically administered corticosteroids is frequent and often can be predicted on the basis of additional patch testing and an established classification scheme. Herein we review allergy due to topically applied corticosteroids with regard to its prevalence, means of testing, cross-reactivity among the subclasses, risk factors, and relationship to steroids.
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Affiliation(s)
- M E Lutz
- Department of Dermatology, Mayo Clinic Rochester, MN 55905, USA
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Gonzalo Garijo MA, Bobadilla González P. Cutaneous-mucosal allergic contact reaction due to topical corticosteroids. Allergy 1995; 50:833-6. [PMID: 8607567 DOI: 10.1111/j.1398-9995.1995.tb05058.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report the case of a 41-year-old nonatopic women with a previous history of eczematous reaction due to hydrocortisone who suffered worsening of her perennial rhinitis in association with perinasal dermatitis from the use of budesonide in nasal spray form, and stomatitis and pharyngitis due to budesonide in a bronchial inhaler. Patch tests with a series of 25 corticosteroids, some of them at different concentrations and in different vehicles, were positive to tixocortol pivalate, hydrocortisone, budesonide, prednisolone, hydrocortisone butyrate propionate, triamcinolone acetonide, and fluocinolone acetonide. For some of them, a 1% solution in ethanol gave a positive reaction when a 20% mixture in petrolatum did not. Like other authors, we suggest that some multiple positives may represent sensitization to several steroids independently, true cross-reactions, or both, and that ethanol is a better vehicle than petrolatum.
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Affiliation(s)
- M A Gonzalo Garijo
- Allergology Department, Infanta Cristina University Hospital, Badajoz, Spain
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Wilkinson SM, Mattey DL, Beck MH. IgG antibodies and early intradermal reactions to hydrocortisone in patients with cutaneous delayed-type hypersensitivity to hydrocortisone. Br J Dermatol 1994; 131:495-8. [PMID: 7947201 DOI: 10.1111/j.1365-2133.1994.tb08549.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Seven of 25 patients with cutaneous delayed-type hypersensitivity to hydrocortisone had an immediate reaction following the intradermal injection of hydrocortisone sodium succinate. Using an ELISA method, we found that these patients had significantly increased levels of IgG antibodies to hydrocortisone when compared with normal blood donors (P < 0.005) and nickel-allergic patients (P < 0.05). We suggest that these patients are at risk of developing type III and possibly type I reactions following the systemic administration of hydrocortisone and that, if needed, an alternative systemic corticosteroid should be used, for example betamethasone or dexamethasone.
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Abstract
BACKGROUND Contact allergy to corticosteroids has recently gained increased attention. METHODS Five cases of contact dermatitis due to budesonide, a nonhalogenated steroid, are described. The Japanese literature was reviewed for reports on this allergy, and the occurrence due to budesonide was compared with that of other dermocorticosteroids. RESULTS Budesonide use can cause contact dermatitis. CONCLUSIONS Although budesonide may be beneficial because of its anti-inflammatory effects, clinicians should be alert to its potential for causing contact dermatitis.
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Affiliation(s)
- M Okano
- Department of Dermatology, Aizembashi Hospital, Osaka, Japan
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11
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Abstract
Contact hypersensitivity from topical corticosteroids is becoming increasingly recognized; it is present in 2-5% of the patients attending contact dermatitis clinics. The use of a corticosteroid series containing tixocortal pivalate 1% (petrolatum), to detect hypersensitivity to hydrocortisone, and other steroids 1% (ethanol), depending on local corticosteroid usage, detects the majority of cases of corticosteroid hypersensitivity. In selected cases, the use of intradermal tests further improves the diagnosis of corticosteroid hypersensitivity. Corticosteroid hypersensitivity occurs most frequently among patients with stasis dermatitis. However, corticosteroid hypersensitivity is also common in other types of dermatitis, occurring as frequently as hypersensitivity to several allergens (e.g. wool alcohols and colophony) in the European standard battery. Although hypersensitivity has mainly been reported with corticosteroids applied to the skin, reactions may also occur on mucosal surfaces, following systemic administration and with sex steroids.
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Dooms-Goossens A, Meinardi MM, Bos JD, Degreef H. Contact allergy to corticosteroids: the results of a two-centre study. Br J Dermatol 1994; 130:42-7. [PMID: 8305315 DOI: 10.1111/j.1365-2133.1994.tb06880.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report a comparative study of the patch-test results obtained with a corticosteroid series, added to the standard series, in two centres, one in Belgium and the other in the Netherlands. The frequencies of positive reactions to the corticosteroids differed considerably between the two centres, and we suggest several reasons for this.
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Affiliation(s)
- A Dooms-Goossens
- Department of Medical Research (Dermatology), University Hospital, Katholieke Universiteit Leuven, Belgium
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Wilkinson SM, English JS, Mattey DL. In vitro evidence of delayed-type hypersensitivity to hydrocortisone. Contact Dermatitis 1993; 29:241-5. [PMID: 8112062 DOI: 10.1111/j.1600-0536.1993.tb03557.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Hypersensitivity to topical hydrocortisone is becoming increasingly recognized. We present further evidence that this is mediated via a delayed-type hypersensitivity reaction. A hydrocortisone: albumin complex was able to induce a proliferative response in the peripheral blood mononuclear cells of patients allergic to hydrocortisone. Protein binding of hydrocortisone or a degradation product may be important in the development of corticosteroid allergy.
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MESH Headings
- Administration, Cutaneous
- Cell Division
- Cells, Cultured
- Dermatitis, Allergic Contact/diagnosis
- Dermatitis, Allergic Contact/immunology
- Drug Eruptions/diagnosis
- Drug Eruptions/immunology
- Humans
- Hydrocortisone/adverse effects
- Hydrocortisone/metabolism
- Hydrocortisone/pharmacology
- Hypersensitivity, Delayed/chemically induced
- Hypersensitivity, Delayed/diagnosis
- Hypersensitivity, Delayed/immunology
- Leukocytes, Mononuclear/drug effects
- Leukocytes, Mononuclear/immunology
- Leukocytes, Mononuclear/pathology
- Protein Binding
- Serum Albumin/adverse effects
- Serum Albumin/pharmacology
- Thymidine
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Affiliation(s)
- S M Wilkinson
- Department of Dermatology, Staffordshire Hospital Centre, Stoke-on-Trent, UK
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Affiliation(s)
- S Veraldi
- 1st Department of Dermatology, University of Milan, Italy
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SHIBAHARA M, NAGATO N, NISHIMOTO K. A Case of Locid(Hydrocortisone Butyrate) Ointment Sensitivity. ACTA ACUST UNITED AC 1993. [DOI: 10.2336/nishinihonhifu.55.649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
BACKGROUND Hypersensitivity to topical steroids is becoming increasingly recognized. OBJECTIVE Our purpose was to establish factors associated with allergy to topical hydrocortisone. METHODS Data from 59 consecutive patients allergic to hydrocortisone were compared with 199 consecutive patients who were not allergic to hydrocortisone. RESULTS Patients with stasis dermatitis and leg ulceration were significantly more likely to be allergic to hydrocortisone. In patients with hand eczema, in whom hydrocortisone sensitivity was less common, hydrocortisone was still a common allergen, occurring as frequently as wool alcohols and colophony. In four patients with atopic eczema, hydrocortisone was the only allergen. Duration of dermatitis was not important in determining the presence of hydrocortisone allergy. However, patients allergic to hydrocortisone were more likely to have multiple allergies when compared with control subjects. CONCLUSION Allergy to topical hydrocortisone is associated with stasis dermatitis and multiple positive patch test reactions.
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Affiliation(s)
- S M Wilkinson
- Dermatology Department, North Staffordshire Hospital Centre, Stoke on Trent, England
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Wilkinson SM, Heagerty AH, English JS. A prospective study into the value of patch and intradermal tests in identifying topical corticosteroid allergy. Br J Dermatol 1992; 127:22-5. [PMID: 1386246 DOI: 10.1111/j.1365-2133.1992.tb14819.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We have prospectively performed patch and intradermal tests on 105 consecutive patients, attending for patch testing, to determine the optimum method of screening for corticosteroid hypersensitivity. Patch tests with Pivalone and a corticosteroid series (all 1% in ethanol) detected all the patients with steroid sensitivity. However, intradermal tests were essential to exclude false positive reactions and detect all relevant steroid allergies in any individual patient.
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Affiliation(s)
- S M Wilkinson
- Dermatology Department, North Staffordshire Hospital Centre, Stoke-on-Trent, U.K
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