Bircher A J, Thürlimann W, Hunziker T, Pasche-Koo F, Hunziker N, Perrenoud D, Elsner P, Schultheiss R
Department of Dermatology, University Hospitals, Basel, Switzerland.
Dermatology. 1995;191(2):109-14. doi: 10.1159/000246526.
Contact hypersensitivity to corticosteroids is increasingly reported and has been identified as a problem of considerable clinical relevance. The prevalence of positive patch tests to corticosteroids ranges from 0.2 up to 5%.
The prevalence of positive patch tests to corticosteroids in Switzerland was determined in a multi-centre study of patients undergoing routine patch tests.
As representatives of corticosteroid groups, the following substances were used for screening: tixocortol pivalate and hydrocortisone for group A (hydrocortisone type), hydrocortisone butyrate for group D (hydrocortisone butyrate type) and budesonide for both groups B (triamcinolone type) and D. Patients positive for at least one corticosteroid were retested with the screening series and 12 corticosteroids commonly used in Switzerland.
Among 3,016 consecutive patients, 65 individuals (2.2%) with a total of 106 positive reactions were found. Retesting showed a concordance of 70-98%, depending on the corticosteroid and the score of the positive reaction. In the subsequently tested corticosteroid series including 12 substances, 19 out of 56 screening-positive patients had a positive result to one or several corticosteroids. There were only few evident cross-reactive patterns in between the corticosteroids tested.
Corticosteroids should be included in routine patch testing, because contact sensitization to a corticosteroid is of considerable practical importance. We confirm that as markers of corticosteroid sensitization tixocortol pivalate, budesonide and hydrocortisone butyrate may be suited, because there is no single corticosteroid which is a marker for all four corticosteroid groups. Patch test reactions of 2+ or higher have a better reproducibility than 1+ reactions.
对皮质类固醇的接触性过敏反应报道日益增多，已被确认为具有相当临床相关性的问题。皮质类固醇斑贴试验阳性率在0.2%至5%之间。
在一项对接受常规斑贴试验患者的多中心研究中，确定瑞士皮质类固醇斑贴试验阳性率。
作为皮质类固醇组的代表，使用以下物质进行筛查：A组（氢化可的松类）用特戊酸替可的松和氢化可的松，D组（丁酸氢化可的松类）用丁酸氢化可的松，B组（曲安奈德类）和D组均用布地奈德。至少对一种皮质类固醇呈阳性的患者，用筛查系列和瑞士常用的12种皮质类固醇进行重新检测。
在3016例连续患者中，发现65例个体（2.2%）共有106次阳性反应。重新检测显示，一致性在70%至98%之间，具体取决于皮质类固醇和阳性反应的评分。在随后检测的包括12种物质的皮质类固醇系列中，56例筛查阳性患者中有19例对一种或几种皮质类固醇呈阳性结果。所检测的皮质类固醇之间只有少数明显的交叉反应模式。
皮质类固醇应纳入常规斑贴试验，因为对皮质类固醇的接触致敏具有相当大的实际重要性。我们证实，作为皮质类固醇致敏的标志物，特戊酸替可的松、布地奈德和丁酸氢化可的松可能适用，因为没有单一的皮质类固醇可作为所有四类皮质类固醇的标志物。2+或更高的斑贴试验反应比1+反应具有更好的可重复性。
