Contact sensitivity to topical corticosteroids.

Five cases of contact sensitivity to topical corticosteroids are described. Two of the five patients presented with chronic hand eczema that was nonresponsive to topical steroid therapy. The others had eruptions suggestive of contact dermatitis. One patient was allergic only to amcinonide , while the other reacted to multiple corticosteroids. Two of them were also sensitive to ethylenediamine. The level of sensitivity can be mild or severe, and some with mild patch test responses are allergic to multiple corticosteroids. These patients often have a history of chronic eczema, e.g., stasis dermatitis, and the presenting complaint ranges from a failure to heal to obvious contact dermatitis. Cross-reactions occur not infrequently (based on similarities in the structure of either the corticosteroid or the ester), but these patterns are probably not sufficiently reliable to use clinically without patch test confirmation. The only treatment required is removal from the offending agent(s) and substitution of a product that does not elicit a reaction on patch testing. The findings in ninety-five other case reports are reviewed, and a practical method for patch testing to these agents is presented.