CONTACT ALLERGY TO TOPICAL CORTICOSTEROID S - PREVALENCE, CROSS-SENSITIVITY, DIAGNOSTIC PROCEDURES

Topical corticosteroids (CS) are frequently used to treat of allergic contact dermatitis, so that their own potential for sensitization is r arely detected. However, increasing numbers of hypersensitivity reacti ons to corticosteroids have been reported during the last 10 years, an d allergic skin reactions to over 50 particular compounds have been ob served. CS must now be regarded as a rather frequent contact allergen, the prevalence being twice as high in women as in men. Contact allerg y to CS is clinically characterized by a chronic and persistent, corti costeroid-resistant dermatitis. In general, hypersensitivity to CS is a type I and/or type IV mediated allergic reaction. Cross-sensitivity between individual corticosteroid preparations has been described owin g to their closely related chemical structures (e.g. hydrocortisone an d tixocortol pivalate). Contact allergy to CS can be confirmed by patc h-tests, intradermal injection tests or application tests; because of the delayed appearance of positive skin reactions a prolonged evaluati on period of up to 120 h is recommended. For routine screening the use of the patient's own material and of tixocortol pivalate and budesoni de as test marker substances seems appropriate. The development of fur ther marker substances is a target for ongoing research.