Contact allergy to topical corticosteroids--results from the IVDK and epidemiological risk assessment.
BACKGROUND
Contact allergy (CA) to topical corticosteroids (CS) is relatively rare; however, current data from Germany are not available. Furthermore, valid risk assessment needs to take into account of the actual exposure to CS in the population.


METHODS
The reaction profile of 9 CS included in a "CS test battery" of the German Contact Dermatitis Research Group (DKG) in patients seen in German clinics belonging to the Information Network of Departments of Dermatology (IVDK; http://www.ivdk.org) between 01/1995 and 12/2004 was analyzed. Applying the "Clinical Epidemiology/Drug Utilization Research" approach, annual incidences of CA to CS in Germany were extrapolated. These estimates were used as numerator for a relative incidence (RI) estimate which used exposure in terms of "defined daily doses" (DDD) to the respective CS as denominator, the latter information collected by the AOK Research Institute (WIdO).


RESULTS
On average, 7.4% of all patients were patch tested with the CS series, mostly yielding < 1% positive reactions. Exceptions included hydrocortisone 17-butyrate (1.5%), amcinonide (1.6%) and budesonide (2.6%). With a RI of 10.7, 23.6 and 4.9 per 100,000 DDD, respectively, the three CS mentioned classify as moderate topical drug allergens. Clobetasol 17-propionate and triamcinolone acetonide both yielded a RI of 1.4/100,000 DDD, indicating low sensitization risk. For hydrocortisone, betamethasone, prednisolone and dexamethasone (RI < 1/100,000 DDD) the risk of sensitization appears minute.


CONCLUSIONS
The results support and extend previous evidence on the CA risk of CS, adding to a therapeutic index and risk assessment.
Uter
Wolfgang
W
Institute for Medical Information Technology, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany. wolfgang.uter@rzmail.uni-erlangen.de
de Pádua
Cristiane Menezes
CM
Pfahlberg
Annette
A
Nink
Katrin
K
Schnuch
Axel
A
Lessmann
Holger
H