Lauerma A I, Reitamo S, Maibach H I
Department of Dermatology, Helsinki University Central Hospital, Finland.
J Am Acad Dermatol. 1991 Feb;24(2 Pt 1):182-5. doi: 10.1016/0190-9622(91)70024-v.
To determine whether systemic hydrocortisone can elicit allergic skin reactions in patients with contact hypersensitivity to hydrocortisone, we studied four patients with contact hypersensitivity to hydrocortisone and hydrocortisone-17-butyrate and two patients with contact hypersensitivity to hydrocortisone-17-butyrate but not to hydrocortisone. Open oral provocation with 100 or 250 mg hydrocortisone in patients with hydrocortisone contact hypersensitivity elicited cutaneous reactions at sites of previous allergic dermatitis caused by hydrocortisone in two patients and at sites of earlier allergic patch test reactions caused by hydrocortisone in the other two patients. Provocations in two patients with contact hypersensitivity to hydrocortisone-17-butyrate but not to hydrocortisone remained negative. To determine whether the adrenal cortical hormone cortisol, which is identical to hydrocortisone, could induce similar skin reactions, one patient with hydrocortisone contact hypersensitivity underwent adrenocorticotropic hormone stimulation tests; as a control, one hydrocortisone-sensitive patient underwent analogous provocations with placebo. After an 8-hour infusion with the adrenocorticotropic hormone analog tetracosactide, a similar skin reaction to that seen with oral hydrocortisone was observed, whereas provocations with placebo remained negative. We conclude that both oral hydrocortisone and intrinsic cortisol are able to induce allergic skin reactions in presensitized subjects.
为了确定全身性氢化可的松是否会在对氢化可的松有接触性超敏反应的患者中引发过敏性皮肤反应，我们研究了4例对氢化可的松和丁酸氢化可的松有接触性超敏反应的患者，以及2例对丁酸氢化可的松有接触性超敏反应但对氢化可的松无接触性超敏反应的患者。对有氢化可的松接触性超敏反应的患者口服100或250 mg氢化可的松进行开放性激发试验，其中2例患者在先前由氢化可的松引起的过敏性皮炎部位出现皮肤反应，另外2例患者在先前由氢化可的松引起的过敏性斑贴试验反应部位出现皮肤反应。对2例对丁酸氢化可的松有接触性超敏反应但对氢化可的松无接触性超敏反应的患者进行的激发试验结果为阴性。为了确定与氢化可的松相同的肾上腺皮质激素皮质醇是否能诱发类似的皮肤反应，1例有氢化可的松接触性超敏反应的患者接受了促肾上腺皮质激素刺激试验；作为对照，1例对氢化可的松敏感的患者用安慰剂进行了类似的激发试验。在用促肾上腺皮质激素类似物二十四肽促皮质素输注8小时后，观察到与口服氢化可的松类似的皮肤反应，而用安慰剂进行的激发试验结果为阴性。我们得出结论，口服氢化可的松和内源性皮质醇均能够在预先致敏的受试者中诱发过敏性皮肤反应。
