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Allergic Contact Dermatitis to Corticosteroids

  • Contact Dermatitis (Brandon Adler and Vincent Deleo, Section editors)
  • Published:
Current Dermatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review summarizes current state of knowledge of allergic contact dermatitis to corticosteroids and highlights recent findings in this field.

Recent Findings

Tixocortol-21-pivalate and budesonide are the most commonly reported corticosteroid allergens. Up to 50% of those who patch-tested positive to corticosteroids were allergic to more than one compound using European baseline series, though there has been significant variation in rates of positive reactions to multiple corticosteroids in previous studies. Steroid classification, while helpful in predicting steroid allergen cross-reactivity, is not always sufficient. Delayed readings on day 7 should be considered when patch testing to corticosteroids.

Summary

Allergic contact dermatitis to corticosteroids can present a diagnostic challenge due to the anti-inflammatory effects and varied clinical presentation and should be considered in any cutaneous eruption that worsens or fails to improve with appropriately utilized corticosteroids. Corticosteroids are classified based on structure and cross-reactivity patterns. Their allergenicity is influenced by molecular structure and configuration, molecular weight, penetration, and speed of degradation. When a delayed hypersensitivity reaction to a corticosteroid is suspected, appropriate patch testing is required for identification of culprit allergen(s) with subsequent avoidance of the allergen itself, as well as known cross-reactors.

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      Authors and Affiliations

      1. Division of Dermatology, University of Ottawa, Ottawa, ON, Canada

        Alison Spurr & Melanie Pratt

      2. Faculty of Medicine, Université Laval, Québec, QC, Canada

        Shaghayegh Shahrigharahkoshan

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      Correspondence to Melanie Pratt.

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      Spurr, A., Pratt, M. & Shahrigharahkoshan, S. Allergic Contact Dermatitis to Corticosteroids. Curr Derm Rep 10, 140–147 (2021). https://doi.org/10.1007/s13671-021-00338-1

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