From the *Division of Dermatology and †Faculty of Medicine, University of Ottawa, Ontario, Canada; ‡Department of Dermatology, University of Minnesota, Minneapolis; §University of California, San Francisco; ∥Department of Dermatology, Cleveland Clinic Lerner College of Medicine, OH; ¶Department of Medicine, Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada; #Division of Dermatology, University of Toronto, Ontario, Canada; **Ohio State University, Columbus; ††Associates in Dermatology, Fort Myers, FL; ‡‡Department of Dermatology, University of Cincinnati, OH; §§Dartmouth-Hitchcock Medical Center, Lebanon, NH; ∥∥University of Southern California, Keck School of Medicine, Los Angeles; ¶¶University of Louisville, KY; ##Department of Dermatology, Pennsylvania State University, University Park, Hershey; ***Department of Dermatology, Oregon Health Science University, Portland; and †††Department of Dermatology, Columbia University, New York, NY.
Dermatitis. 2017 Jan/Feb;28(1):58-63. doi: 10.1097/DER.0000000000000251.
Corticosteroids may cause delayed hypersensitivity. On the basis of structure, the following 4 groups of corticosteroids are recognized: A, B, C, and D (subdivided into D1 and D2). More recently, a newer classification system subdivides corticosteroids into groups 1, 2, and 3. Cross-reactions are unpredictable. The objective of this study was to describe positive patch test and co-reaction patterns to corticosteroids.
A retrospective analysis of 17,978 patients patch tested by the North American Contact Dermatitis Group between 2007 and 2014 was performed. Corticosteroids tested during this period included the following: tixocortol-21-pivalate 1.0% petroleum (pet), budesonide 0.1% pet, triamcinolone acetonide 1.0% pet, desoximetasone 1.0% pet, clobetasol-17-propionate 1.0% pet, and hydrocortisone-17-butyrate (HC-17-B) 1.0% (pet and alcohol). Overall, 4.12% (n = 741) of patients had 1 or more positive reactions to corticosteroids. Tixocortol-21-pivalate positivity was the most common (2.26%), followed by budesonide (0.87%), HC-17-B (0.43%), clobetasol-17-proprionate (0.32%), and desoximetasone (0.16%). Reaction strength was strong (++ or +++) in almost twice as many tixocortol and budesonide reactions (>64%) as compared with the other 3 corticosteroids (<34.5%). Of the patients with positive corticosteroid reactions (n = 741), most (70.7%) had sensitivity to only 1 corticosteroid. Co-reactivity was highest between desoximetasone and budesonide.
Sensitivity to corticosteroids is important. Consistent with other studies, the highest frequency of corticosteroid positivity was seen in group A (tixocortol-21-pivalate), followed by group B (budesonide) and D2 (HC-17-B). Co-reactivity varied; more studies are needed to fully understand structural cross-reactivity.
皮质类固醇可能引起迟发性超敏反应。基于结构，以下四类皮质类固醇被识别：A、B、C 和 D（进一步细分为 D1 和 D2）。最近，一种新的分类系统将皮质类固醇分为 1、2 和 3 组。交叉反应是不可预测的。本研究的目的是描述皮质类固醇的阳性斑贴试验和共同反应模式。
对 2007 年至 2014 年期间北美接触性皮炎组进行斑贴试验的 17978 例患者进行回顾性分析。在此期间测试的皮质类固醇包括以下内容：三氯醋酸 21-戊酸酯 1.0%石油（pet）、布地奈德 0.1% pet、曲安奈德丙酮 1.0% pet、去氧米松 1.0% pet、氯倍他索-17-丙酸酯 1.0% pet 和氢化可的松-17-丁酸酯（HC-17-B）1.0%（pet 和酒精）。总体而言，4.12%（n=741）的患者对皮质类固醇有 1 种或多种阳性反应。三氯醋酸 21-戊酸酯阳性率最高（2.26%），其次是布地奈德（0.87%）、HC-17-B（0.43%）、氯倍他索-17-丙酸酯（0.32%）和去氧米松（0.16%）。与其他 3 种皮质类固醇（<34.5%）相比，几乎有两倍的三氯醋酸和布地奈德反应（>64%）强度为强（++或+++）。在有阳性皮质类固醇反应的患者中（n=741），大多数（70.7%）对 1 种皮质类固醇敏感。最常见的共同反应是去氧米松和布地奈德之间的反应。
对皮质类固醇的敏感性很重要。与其他研究一致，皮质类固醇阳性率最高的是 A 组（三氯醋酸 21-戊酸酯），其次是 B 组（布地奈德）和 D2 组（HC-17-B）。共同反应不同；需要更多的研究来充分了解结构交叉反应。
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