Contact sensitization to corticosteroids: increased risk in long term dermatoses

Patients affected by chronic dermatoses are at high risk for the developmen t of sensitization to corticosteroids, This study was carried out to evalua te contact hypersensitivity to corticosteroids in a selected group of patie nts affected by longlasting cutaneous dermatoses, Sixty subjects underwent the GIRDCA series. The Italian GIRDCA series we applied had the following s ubstances in addition to the European standard series: imidazolidinyl urea 2% pet, thiomersal 0.1% pet, disperse yellow 31% pet, disperse red 1% pet, 4'4-diaminodiphenylmethane 0.5 % pet, ammoniated mercury 1% pet. The patien ts were tested with our corticosteroids series and some of them also with t heir own steroid products. Allergic reactions to corticosteroids were obser ved in 8/60 (13.3%) patients; budesonide was the main sensitizer (7 positiv es) followed by hydrocortisone-17-butyrate and betamethasone-17-valerate (2 and 1 positives, respectively). One patient also reacted to methylpredniso lone aceponate contained in her own cream. 4/8 positives were certainly rel ated to previous drug-exposure. This study showed a very high percentage of sensitization to corticosteroid s, In our opinion, this value may be due both to our selection-standards an d to the wide employment of a well known sensitizer like budesonide in our country. Although a corticosteroids series like ours seems to be adequate f or the detection of sensitized patients, patch tests with individual compou nds and/or steroids corresponding to local prescription habits are recommen ded, especially in unresponsive chronic dermatoses.