Imameldin Asaad, Ibrahim Yaldez, Ibrahim Tayseer, Mobayed Hassan
Adult Allergy and Immunology Division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail:
Qatar Med J. 2022 Apr 1;2022(2):9. doi: 10.5339/qmj.2022.fqac.9. eCollection 2022.
Skin prick test (SPT) and intradermal test (IDT) are standard procedures in the allergy practice that are safe when performed. Individuals with a history of allergic reaction to the COVID-19 vaccine can undergo allergy skin testing for polyethylene glycol and polysorbate 80 to determine their eligibility for the same vaccine or a safe alternative. Hypopigmentation is an infrequent adverse effect of corticosteroids, including triamcinolone acetonide, following local and intralesional treatment. Exposure to high potency corticosteroids for a long duration and the intradermal injection route are risk factors for hypopigmentation. In this case report, we describe the development of hypopigmentation following triamcinolone ID testing.
A 29-year-old lady with a history of immediate severe allergic reaction following the first dose of mRNA COVID-19 vaccine (Pfizer) underwent SPT and IDT for polysorbate 80 and polyethylene glycol. Triamcinolone acetonide and Prevnar 13 were used as an indicator of polysorbate 80. Following a negative SPT, IDT for triamcinolone acetonide was negative at 1:10 of 40 mg/mL and positive at 1:1 of 40 mg/mL. A few days later, she noticed hypopigmented lesions at the site of the intradermal skin test for both concentrations of triamcinolone. The lesions have increased in size since then (see image). The patient was diagnosed with steroid-induced hypopigmentation secondary to triamcinolone IDT injection.
Skin hypopigmentation following intraarticular and intralesional triamcinolone injection has been reported previously. However, to the best of our knowledge, this is the first reported case of steroid-induced hypopigmentation following intradermal skin testing. Furthermore, this report highlights that even a low dose of local triamcinolone can cause hypopigmentation. We believe that this case report regarding the rare adverse event will alert clinicians to the potential complication of corticosteroid IDT and help them counsel the patients and provide a thorough explanation before any procedure.
皮肤点刺试验（SPT）和皮内试验（IDT）是过敏诊疗中的标准程序，操作时是安全的。有对新冠病毒疫苗过敏反应史的个体可接受针对聚乙二醇和聚山梨酯80的过敏皮肤试验，以确定其是否适合接种同一疫苗或安全替代疫苗。色素减退是包括曲安奈德在内的皮质类固醇在局部和病灶内治疗后不常见的不良反应。长期暴露于高效能皮质类固醇以及皮内注射途径是色素减退的危险因素。在本病例报告中，我们描述了曲安奈德皮内试验后色素减退的发生情况。
一名29岁女性，在接种第一剂mRNA新冠病毒疫苗（辉瑞）后出现即刻严重过敏反应，接受了针对聚山梨酯80和聚乙二醇的SPT和IDT。曲安奈德和沛儿13被用作聚山梨酯80的指示剂。SPT结果为阴性后，曲安奈德的IDT在40mg/mL的1:10浓度时为阴性，在1:1浓度时为阳性。几天后，她注意到两种浓度曲安奈德皮内皮肤试验部位出现色素减退性皮损。从那时起，皮损面积增大（见图）。该患者被诊断为曲安奈德皮内注射所致的类固醇诱导性色素减退。
此前已有关于关节内和病灶内注射曲安奈德后皮肤色素减退的报道。然而，据我们所知，这是首例皮内皮肤试验后类固醇诱导性色素减退的报道。此外，本报告强调即使是低剂量的局部曲安奈德也可导致色素减退。我们认为，这份关于罕见不良事件的病例报告将提醒临床医生注意皮质类固醇皮内试验的潜在并发症，并帮助他们在任何操作前为患者提供咨询并进行充分解释。
