title: Patch, prick or intradermal tests to detect delayed hypersensitivity to corticosteroids?
abstract: BACKGROUND
  Contact allergy to topical corticosteroids is usually detected by patch testing.
  
  
  OBJECTIVE
  This study compares the test results obtained with patch, prick and intradermal testing, to assess the most sensitive method for diagnosing corticosteroid hypersensitivity.
  
  
  METHODS
  Nineteen corticosteroid-allergic subjects and three control subjects were included. Patch, prick and intradermal tests were performed with five commercial corticosteroid preparations, as well as with the respective active principles diluted in ethanol. The test readings were performed at different time points, i.e. at 8, 24, 48 and 96 hr, and at 7 days.
  
  
  RESULTS
  Patch tests with ethanolic preparations produced more positive reactions than the commercial ones. The intradermal tests became positive earlier than the patch tests, a concordance between patch and intradermal tests being found in 11/15 (two positive intradermal test results with negative patch test results and vice versa). However, several subjects developed skin atrophy (14/22) at intradermal injection sites.
  
  
  CONCLUSIONS
  Patch testing with the active principles diluted in ethanol remains the diagnostic method of choice for the detection of delayed hypersensitivity to corticosteroids. Intradermal tests with late readings, despite detecting additional contact allergy cases, should not be routinely performed, because of an important risk of atrophy, particularly with corticosteroid suspensions.
authors.affiliation: Department of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium.
authors.forename: Angèle
authors.initials: A
authors.lastname: Soria
authors.forename: Marie
authors.initials: M
authors.lastname: Baeck
authors.forename: An
authors.initials: A
authors.lastname: Goossens
authors.forename: Liliane
authors.initials: L
authors.lastname: Marot
authors.forename: Vèronique
authors.initials: V
authors.lastname: Duveille
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Derouaux
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Nicolas
authors.forename: Dominique
authors.initials: D
authors.lastname: Tennstedt
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003879:Dermatologic Agents / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced / Q000175:diagnosis*; D007428:Intradermal Tests; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D012680:Sensitivity and Specificity; D012882:Skin Tests; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D003879:Dermatologic Agents