title: Patch Test Reactions to Corticosteroids: Retrospective Analysis From the North American Contact Dermatitis Group 2007-2014.
abstract: BACKGROUND
  Corticosteroids may cause delayed hypersensitivity. On the basis of structure, the following 4 groups of corticosteroids are recognized: A, B, C, and D (subdivided into D1 and D2). More recently, a newer classification system subdivides corticosteroids into groups 1, 2, and 3. Cross-reactions are unpredictable. The objective of this study was to describe positive patch test and co-reaction patterns to corticosteroids.
  
  
  RESULTS
  A retrospective analysis of 17,978 patients patch tested by the North American Contact Dermatitis Group between 2007 and 2014 was performed. Corticosteroids tested during this period included the following: tixocortol-21-pivalate 1.0% petroleum (pet), budesonide 0.1% pet, triamcinolone acetonide 1.0% pet, desoximetasone 1.0% pet, clobetasol-17-propionate 1.0% pet, and hydrocortisone-17-butyrate (HC-17-B) 1.0% (pet and alcohol). Overall, 4.12% (n = 741) of patients had 1 or more positive reactions to corticosteroids. Tixocortol-21-pivalate positivity was the most common (2.26%), followed by budesonide (0.87%), HC-17-B (0.43%), clobetasol-17-proprionate (0.32%), and desoximetasone (0.16%). Reaction strength was strong (++ or +++) in almost twice as many tixocortol and budesonide reactions (>64%) as compared with the other 3 corticosteroids (<34.5%). Of the patients with positive corticosteroid reactions (n = 741), most (70.7%) had sensitivity to only 1 corticosteroid. Co-reactivity was highest between desoximetasone and budesonide.
  
  
  CONCLUSIONS
  Sensitivity to corticosteroids is important. Consistent with other studies, the highest frequency of corticosteroid positivity was seen in group A (tixocortol-21-pivalate), followed by group B (budesonide) and D2 (HC-17-B). Co-reactivity varied; more studies are needed to fully understand structural cross-reactivity.
authors.affiliation: From the *Division of Dermatology and †Faculty of Medicine, University of Ottawa, Ontario, Canada; ‡Department of Dermatology, University of Minnesota, Minneapolis; §University of California, San Francisco; ∥Department of Dermatology, Cleveland Clinic Lerner College of Medicine, OH; ¶Department of Medicine, Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada; #Division of Dermatology, University of Toronto, Ontario, Canada; **Ohio State University, Columbus; ††Associates in Dermatology, Fort Myers, FL; ‡‡Department of Dermatology, University of Cincinnati, OH; §§Dartmouth-Hitchcock Medical Center, Lebanon, NH; ∥∥University of Southern California, Keck School of Medicine, Los Angeles; ¶¶University of Louisville, KY; ##Department of Dermatology, Pennsylvania State University, University Park, Hershey; ***Department of Dermatology, Oregon Health Science University, Portland; and †††Department of Dermatology, Columbia University, New York, NY.
authors.forename: Melanie D
authors.initials: MD
authors.lastname: Pratt
authors.forename: Asfandyar
authors.initials: A
authors.lastname: Mufti
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lipson
authors.forename: Erin M
authors.initials: EM
authors.lastname: Warshaw
authors.forename: Howard I
authors.initials: HI
authors.lastname: Maibach
authors.forename: James S
authors.initials: JS
authors.lastname: Taylor
authors.forename: Denis
authors.initials: D
authors.lastname: Sasseville
authors.forename: Joel G
authors.initials: JG
authors.lastname: DeKoven
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Zirwas
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Fransway
authors.forename: C G Toby
authors.initials: CG
authors.lastname: Mathias
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Zug
authors.forename: Vincent A
authors.initials: VA
authors.lastname: DeLeo
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Fowler
authors.forename: James G
authors.initials: JG
authors.lastname: Marks
authors.forename: Frances J
authors.initials: FJ
authors.lastname: Storrs
authors.forename: Donald V
authors.initials: DV
authors.lastname: Belsito
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D018926:Anti-Allergic Agents / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D003877:Dermatitis, Contact / Q000209:etiology*; D003875:Drug Eruptions / Q000209:etiology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D009656:North America; D010328:Patch Tests; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D018926:Anti-Allergic Agents; D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone